Quality of life changes and intensive care preferences in terminal cancer patients.
OBJECTIVE
There is scarce research on the short-term fluctuations in end-of-life (EoL) care planning for seriously ill patients. The aim of our study was to investigate the stability of preferences regarding treatment in an intensive care unit (ICU) and identify the factors associated with changes in preferences in terms of quality of life (QoL).


METHODS
A prospective examination on preference changes for ICU care in 141 terminal cancer patients was conducted. Patients were categorized according to their change in preference during the final two months of their lives into four categories: (1) the keep-accept group, (2) the keep-reject group, (3) the change to accept group, and (4) the change to reject group. Using multiple logistic analyses, we explored the association between patient demographics, health-related QoL, and changes in ICU preference.


RESULTS
The overall stability of ICU preferences near the end of life was 66.7% (κ = 0.33, p < 0.001). Married patients were more likely to change their preference regarding ICU care [adjusted odds ratio (aOR) toward accept 12.35, p = 0.021; aOR toward reject 10.56, p = 0.020] than unmarried patients. Patients with stable physical function tended to accept ICU care (aOR = 5.05, p = 0.023), whereas those with poor performance (aOR = 5.32, p = 0.018), worsened QoL (aOR = 8.34, p = 0.007), or non-aggravated fatigue (aOR = 8.36, p = 0.006) were more likely to not accept ICU care.


CONCLUSIONS
The attitudes of terminally ill cancer patients regarding ICU care at the end of life were not stable over time, and changes in their QoL were associated with a tendency to change their preferences about ICU care. Attention should thus be paid to patients' QoL changes to improve medical decision making with regard to EoL care.
Department of Family Medicine,Gachon University Gil Medical Center,Incheon,Republic of Korea.
In Cheol
IC
Hwang
Department of Internal Medicine,Seoul National University Hospital,Seoul,Republic of Korea.
Bhumsuk
B
Keam
Cancer Research Institute and Department of Biomedical Science, Seoul National University Hospital and College of Medicine,Seoul,Republic of Korea.
Young Ho
YH
Yun
Department of Statistics,Dongguk University,Seoul,Republic of Korea.
Hong Yup
HY
Ahn
Research Institute and Hospital, National Cancer Center,Goyang,Republic of Korea.
Young-Ae
YA
Kim
D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy; D057240:Patient Preference; D011788:Quality of Life; D056910:Republic of Korea; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000379:methods / Q000523:psychology*; D019452:Terminally Ill / Q000523:psychology*
Changes; Intensive care unit; Preference; Quality of life; Terminal care