title: Physician-patient end-of-life care discussions: correlates and associations with end-of-life care preferences of cancer patients-a cross-sectional survey study.
abstract: BACKGROUND
  Honoring patients' treatment preferences is a key component of high-quality end-of-life care. Connecting clinical practices to patients' preferences requires effective communication. However, few cancer patients reported discussing end-of-life-care preferences with their physicians.
  
  
  OBJECTIVE
  To identify correlates of physician-patient end-of-life-care discussions and to investigate associations of physician-patient end-of-life-care discussions with patient end-of-life-care preferences.
  
  
  METHODS
  A cross-sectional survey from April 2011 through November 2012.
  
  
  METHODS
  A convenience sample of 2467 cancer patients (89.3% participation rate) whose disease was diagnosed as terminal and unresponsive to current curative cancer treatment was recruited from 23 teaching hospitals throughout Taiwan.
  
  
  RESULTS
  Only 7.8% of respondents reported discussing end-of-life-care preferences with their physicians. Physicians were more likely to discuss end-of-life-care preferences with cancer patients who accurately understood their prognosis but less likely to do so if patients were married or received care in a hospital with an inpatient hospice unit. Furthermore, physician-patient end-of-life-care discussions were significantly, positively associated with the likelihood of preferring comfort-oriented care and hospice care, but negatively associated with preferences for receiving cardiopulmonary resuscitation when life is in danger and aggressive life-sustaining treatments at end of life, including intensive care unit admission, cardiac massage, intubation, and mechanical ventilation support.
  
  
  CONCLUSIONS
  Physician-patient end-of-life-care discussions are correlated with accurate prognostic awareness, marital status, and institutional characteristics and negatively associated with terminally ill cancer patients' preferences for aggressive end-of-life care. Interventions should be developed to facilitate timely end-of-life-care discussions between at-risk patients and their physicians, thus honoring patients' end-of-life-care preferences and possibly avoiding futile life-sustaining treatments.
authors: School of Nursing, Chang Gung University, Tao-Yuan, Taiwan sttang@mail.cgu.edu.tw.
authors: Siew Tzuh
authors: ST
authors: Tang
authors: National Institute of Cancer Research, National Health Research Institutes, Taipei, Taiwan.
authors: Tsang-Wu
authors: TW
authors: Liu
authors: Department of Nursing, Fu Jen Catholic University, Taipei, Taiwan.
authors: Li Ni
authors: LN
authors: Liu
authors: Division of Hematology-Oncology and Comprehensive Cancer Center, China Medical University Hospital, Taichung, Taiwan.
authors: Chang-Fang
authors: CF
authors: Chiu
authors: Division of Hematology and Oncology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
authors: Ruey-Kuen
authors: RK
authors: Hsieh
authors: Chest Department, Taipei Veterans General Hospital, Taipei, Taiwan.
authors: Chun-Ming
authors: CM
authors: Tsai
mesh_terms: D000328:Adult; D032722:Advance Care Planning / Q000592:standards*; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality / Q000628:therapy; D057240:Patient Preference; D010817:Physician-Patient Relations; D013727:Terminal Care / Q000523:psychology*; D055815:Young Adult
keywords: Advance care planning; end-of-life care; end-of-life-care discussions; physician–patient communication; preferences; terminal care