title: Trajectory and predictors of quality of life during the dying process: roles of perceived sense of burden to others and posttraumatic growth.
abstract: OBJECTIVE
  Quality of life (QOL) at end of life (EOL) is related to important themes, e.g., "sense of burden to others" and "perceived posttraumatic growth," which have never been investigated concurrently. The purposes of this study were: (1) to describe the trajectory of QOL during the dying process and (2) to identify determinants of QOL, including the roles of perceived sense of burden to others and posttraumatic growth.
  
  
  METHODS
  A convenience sample of 313 terminally ill cancer patients was surveyed and longitudinally followed until death. QOL was measured by a modified McGill quality of life scale, and determinants were evaluated by a multiple linear regression model with the generalized estimating equation.
  
  
  RESULTS
  Terminally ill Taiwanese cancer patients' QOL decreased substantially as their death approached. However, after controlling for confounders, patients' QOL did not change significantly in the last months of their life. QOL was significantly better for female and non-middle-aged patients with a religious affiliation of Buddhism/Taoism. Poorer QOL tended to be experienced by patients with greater physical symptom distress, anxiety, and depression. Patient QOL increased with greater tangible support, but decreased with greater emotional and affectionate social support. QOL was diminished by a greater degree of perceived burden to others but improved with greater perceived posttraumatic growth.
  
  
  CONCLUSIONS
  Deteriorating QOL as death approaches may not be inevitable. Optimal QOL at EOL may be achieved by interventions designed to adequately manage physical and psychological symptoms, enhance social support, lighten perceived sense of burden to others, and facilitate experiences of posttraumatic growth.
authors.affiliation: School of Nursing, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan, 333, Taiwan, Republic of China, sttang@mail.cgu.edu.tw.
authors.forename: Siew Tzuh
authors.initials: ST
authors.lastname: Tang
authors.forename: Wen-Cheng
authors.initials: WC
authors.lastname: Chang
authors.forename: Jen-Shi
authors.initials: JS
authors.lastname: Chen
authors.forename: Po-Jung
authors.initials: PJ
authors.lastname: Su
authors.forename: Chia-Hsun
authors.initials: CH
authors.lastname: Hsieh
authors.forename: Wen-Chi
authors.initials: WC
authors.lastname: Chou
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D017281:Cost of Illness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology*; D013727:Terminal Care