title: Trajectories of the multidimensional dying experience for terminally ill cancer patients.
abstract: BACKGROUND
  Studies exploring the trajectories of physical-psychological-social-spiritual dying experiences frequently treat changes in these experiences as consistent across different domains and over time.
  
  
  OBJECTIVE
  This prospective, longitudinal investigation was designed to characterize trajectories of the multidimensional dying experience for cancer patients in their last year of life.
  
  
  METHODS
  Trajectories of physical-psychological-social-spiritual/existential dimensions and overall quality of life (QOL) were identified among 313 cancer patients using mixed-effects models to test for linear, quadratic, or cubic changes. Changes in each variable were evaluated for clinical significance using minimal important difference.
  
  
  RESULTS
  When patients transitioned to their end of life, symptom distress, functional dependence, anxiety, and depressive symptoms slightly increased, followed by a stable status for approximately four to six months, and accelerated dramatically to the first clinically significant changes at three to four months before death. Perceived social support and post-traumatic growth declined gradually to clinically significant changes at one and four months before death, respectively. Perceived sense of burden to others increased steadily in the last year of life, with no clinically significant changes identified. Overall QOL deteriorated gradually in the last year but did not reach a clinically significant change until 2.5 months before death.
  
  
  CONCLUSIONS
  All dimensions deteriorated in the last year of life but with distinctive physical-psychological-social-spiritual/existential and overall QOL trajectories. Recognizing trajectory patterns and tipping points of accelerating deterioration in each dimension can help clinicians anticipate times of increased distress, initiate timely, effective interventions to relieve patient suffering, and facilitate high-quality end-of-life care tailored to patients' needs and preferences.
authors.affiliation: School of Nursing, Chang Gung University, Tao-Yuan, Taiwan, Republic of China. Electronic address: sttang@mail.cgu.edu.tw.
authors.forename: Siew T
authors.initials: ST
authors.lastname: Tang
authors.affiliation: Department of Nursing, Fu Jen Catholic University, Taipei, Taiwan, Republic of China.
authors.forename: Li N
authors.initials: LN
authors.lastname: Liu
authors.affiliation: Department of Health Care and Management, National Taipei University of Nursing and Health Science, Taipei, Taiwan, Republic of China.
authors.forename: Kuan-Chia
authors.initials: KC
authors.lastname: Lin
authors.affiliation: Department of Health Care and Management, National Taipei University of Nursing and Health Science, Taipei, Taiwan, Republic of China.
authors.forename: Jui-Hung
authors.initials: JH
authors.lastname: Chung
authors.affiliation: Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taipei, Taiwan, Republic of China.
authors.forename: Chia-Hsun
authors.initials: CH
authors.lastname: Hsieh
authors.affiliation: Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taipei, Taiwan, Republic of China.
authors.forename: Wen-Chi
authors.initials: WC
authors.lastname: Chou
authors.affiliation: Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taipei, Taiwan, Republic of China.
authors.forename: Po-Jung
authors.initials: PJ
authors.lastname: Su
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety; D001294:Attitude to Health; D017281:Cost of Illness; D003863:Depression; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000503:physiopathology* / Q000523:psychology*; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index; D012944:Social Support; D029181:Spirituality; D019452:Terminally Ill / Q000523:psychology*
keywords: Trajectory; functional dependence; post-traumatic growth; psychological distress; quality of life; sense of burden to others; symptom distress