title: The impact of awareness of terminal illness on quality of death and care decision making: a prospective nationwide survey of bereaved family members of advanced cancer patients.
abstract: OBJECTIVE
  We aimed to assess whether awareness of a terminal illness can affect care decision making processes and the achievement of a good death in advanced cancer patients receiving palliative care services.
  
  
  METHODS
  Awareness of terminal illness at the time of palliative care service admission was assessed by the health care professionals during the routine initial comprehensive assessment process and was recorded in the national terminal cancer patient registry. A follow-up nationwide bereavement survey was conducted, which contained questions regarding decision making processes and the Korean version of the Good Death Inventory.
  
  
  RESULTS
  Among the 345 patients included in the final analysis, the majority (68.4%) of the patients were aware of the terminal illness. Awareness of the terminal illness tended to reduce discordances in care decision making (adjusted odds ratio = 0.55; 95% CI: 0.29-1.07), and increased the patients' own decision making when there were discordances between patients and their families (adjusted odds ratio = 3.79; 95% CI: 1.31-10.94). The Good Death Inventory score was significantly higher among patients who were aware of their terminal illnesses compared with those who were not (5.04 vs. 4.80; p = 0.013) and especially in the domains of 'control over the future' (5.18 vs. 4.04; p < 0.001), 'maintaining hope and pleasure' (4.55 vs. 3.92; p = 0.002), and 'unawareness of death' (4.41 vs. 4.26; p = 0.024).
  
  
  CONCLUSIONS
  Awareness of the terminal illness had beneficial effect on the harmonious decision making, patient autonomy, and patient's quality of death. Disclosure of terminal illness should be encouraged.
authors.affiliation: Department of Family Medicine, Family Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Eunmi
authors.initials: E
authors.lastname: Ahn
authors.forename: Dong Wook
authors.initials: DW
authors.lastname: Shin
authors.forename: Jin Young
authors.initials: JY
authors.lastname: Choi
authors.forename: Jina
authors.initials: J
authors.lastname: Kang
authors.forename: Dae Kyun
authors.initials: DK
authors.lastname: Kim
authors.forename: Hyesuk
authors.initials: H
authors.lastname: Kim
authors.forename: Eunil
authors.initials: E
authors.lastname: Lee
authors.forename: Kwan Ok
authors.initials: KO
authors.lastname: Hwang
authors.forename: Bumjo
authors.initials: B
authors.lastname: Oh
authors.forename: BeLong
authors.initials: B
authors.lastname: Cho
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D001364:Awareness; D001601:Bereavement; D003657:Decision Making; D005190:Family; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms; D010166:Palliative Care; D010358:Patient Participation; D011446:Prospective Studies; D013727:Terminal Care; D055815:Young Adult
keywords: awareness of terminal illness; cancer; decision making; oncology; quality of death