title: Does death anxiety affect end-of-life care discussions?
abstract: OBJECTIVE
  The aim of this study was to determine if a gynecologic cancer patient's comfort level discussing end-of-life care issues with her caregivers is related to her death anxiety level.
  
  
  METHODS
  Gynecologic oncology clinic patients were asked to rate their degree of agreeability with 4 statements regarding comfort level discussing end-of-life care issues. Participants also completed the Hoge's Intrinsic Religiosity Scale and Templer's Death Anxiety Scale.
  
  
  RESULTS
  Four hundred one surveys were distributed. One hundred twenty-nine patients participated, with a response rate of 32.2%. The median age of the sample was 55 years. Most patients were white (72.9%), married (58.9%), and Christian (85.3%). Most patients had ovarian cancer (40.4%). Of the 74 patients who knew their cancer stage, 59% had been diagnosed with advanced (stage III-IV) disease. Thirty-three percent were currently in remission, and 17% had recurrent disease. Of all patients surveyed, 32.6% were currently receiving treatment. Chemotherapy was the most common treatment (62% of those being treated). Higher level of comfort discussing end-of-life care topics such as do-not-resuscitate orders with family members was significantly associated with decreased death anxiety (P = 0.008 and P = 0.001). There was no significant association between comfort level when patients discussed do-not-resuscitate orders with physicians and patients' death anxiety (P = 0.14). After controlling for age, race, marital status, education level, current treatment status, and religiosity, linear regression analysis demonstrated that the relationship between a patient's increased comfort level when discussing end-of-life care topics with family members and decreased death anxiety remained statistically significant (P = 0.005 and P = 0.001).
  
  
  CONCLUSIONS
  Conversations regarding goals of treatment are an important component of caring for cancer patients. Death anxiety may contribute to decreased communication between patients and their family members regarding the patient's end-of-life care wishes. Obtaining a better understanding of the role death anxiety plays in end-of-life care discussions may help patients receive the end-of-life care they desire.
authors.affiliation: *Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX; †Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY; ‡Department of Gynecologic Oncology, The Johns Hopkins Hospital; and §Department of Gynecologic Oncology, Mercy Hospital, Baltimore, MD.
authors.forename: Alaina J
authors.initials: AJ
authors.lastname: Brown
authors.forename: Megan J
authors.initials: MJ
authors.lastname: Shen
authors.forename: Lois M
authors.initials: LM
authors.lastname: Ramondetta
authors.forename: Diane C
authors.initials: DC
authors.lastname: Bodurka
authors.forename: Robert L
authors.initials: RL
authors.lastname: Giuntoli
authors.forename: Teresa
authors.initials: T
authors.lastname: Diaz-Montes
mesh_terms: D000328:Adult; D032722:Advance Care Planning / Q000706:statistics & numerical data; D001007:Anxiety / Q000453:epidemiology / Q000523:psychology*; D001293:Attitude to Death; D003657:Decision Making; D005260:Female; D005833:Genital Neoplasms, Female / Q000453:epidemiology / Q000523:psychology*; D006801:Humans; D008875:Middle Aged; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000523:psychology; D055815:Young Adult