title: Cancer patient autonomy and quality of dying-a prospective nationwide survey in Taiwan.
abstract: BACKGROUND
  Patient autonomy is an essential factor in the measurement of quality of dying. We aimed to conduct a study to investigate the factors affecting the autonomy of advanced cancer patients in Taiwan.
  
  
  METHODS
  We conducted a prospective, multicenter study and recruited 574 advanced cancer patients from four inpatient hospice wards in Taiwan; their quality of dying was measured using the validated good death scale and the audit scale. Physician-assessed autonomy and the other scales were measured in a team conference by the primary care physician and the team 1 week after the patient had passed away. The good death scale was measured twice, once at admission and then after the patient had passed away for comparison. We measured factors affecting the improvement in quality of dying of these patients initially by applying multiple linear regression analysis. Then, taking physician-assessed autonomy as a dependent variable, we identified the factors that affected this variable.
  
  
  RESULTS
  The good death score at admission, clear consciousness, number of admission days beyond 7, better physical care, higher physician-assessed autonomy, better emotional support, better communication, better continuity of life, and physician-reported rate of closure were factors affecting the quality of dying. Further analysis identified age (p = 0.031), consciousness (p = 0.01), and total good death scale score at death (p < 0.001) as determinants of physician-assessed autonomy.
  
  
  CONCLUSIONS
  We concluded that physician-assessed autonomy would affect a good death and was highly correlated with age, consciousness level, and quality of dying at the end for advanced cancer patients in Taiwan.
authors.affiliation: Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan.
authors.forename: Shao-Yi
authors.initials: SY
authors.lastname: Cheng
authors.affiliation: Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.|School of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Wen-Yuan
authors.initials: WY
authors.lastname: Lin
authors.affiliation: Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Ya-Hui
authors.initials: YH
authors.lastname: Cheng
authors.affiliation: Department of Community and Family Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan.
authors.forename: Chien Hsiun
authors.initials: CH
authors.lastname: Huang
authors.affiliation: Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan.
authors.forename: Ching-Yu
authors.initials: CY
authors.lastname: Chen
authors.affiliation: Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.|School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Shinn-Jang
authors.initials: SJ
authors.lastname: Hwang
authors.affiliation: Center for Preventive Service, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.|College of Medicine, Tzu Chi University, Hualien, Taiwan.
authors.forename: Shih-Tzu
authors.initials: ST
authors.lastname: Tsai
authors.affiliation: Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan.
authors.forename: Tai-Yuan
authors.initials: TY
authors.lastname: Chiu
mesh_terms: D000368:Aged; D001293:Attitude to Death; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000523:psychology*; D010166:Palliative Care / Q000523:psychology*; D026684:Personal Autonomy; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013624:Taiwan; D013727:Terminal Care / Q000523:psychology*; D019452:Terminally Ill / Q000523:psychology*