title: Preferences for Life-Sustaining Treatments and Associations With Accurate Prognostic Awareness and Depressive Symptoms in Terminally Ill Cancer Patients' Last Year of Life.
abstract: BACKGROUND
  The stability of life-sustaining treatment (LST) preferences at end of life (EOL) has been established. However, few studies have assessed preferences more than two times. Furthermore, associations of LST preferences with modifiable variables of accurate prognostic awareness, physician-patient EOL care discussions, and depressive symptoms have been investigated in cross-sectional studies only.
  
  
  OBJECTIVE
  To explore longitudinal changes in LST preferences and their associations with accurate prognostic awareness, physician-patient EOL care discussions, and depressive symptoms in terminally ill cancer patients' last year.
  
  
  METHODS
  LST preferences (cardiopulmonary resuscitation, intensive care unit [ICU] care, intubation, and mechanical ventilation) were measured approximately every two weeks. Changes in LST preferences and their associations with independent variables were examined by hierarchical generalized linear modeling with logistic regression.
  
  
  RESULTS
  Participants (n = 249) predominantly rejected cardiopulmonary resuscitation, ICU care, intubation, and mechanical ventilation at EOL without significant changes as death approached. Patients with inaccurate prognostic awareness were significantly more likely than those with accurate understanding to prefer ICU care, intubation, and mechanical ventilation than to reject these LSTs. Patients with more severe depressive symptoms were less likely to prefer ICU care and to be undecided about wanting ICU care and mechanical ventilation than to reject such LSTs. LST preferences were not associated with physician-patient EOL care discussions, which were rare in our sample.
  
  
  CONCLUSIONS
  LST preferences are stable in cancer patients' last year. Facilitating accurate prognostic awareness and providing adequate psychological support may counteract the increasing trend for aggressive EOL care and minimize emotional distress during EOL care decisions.
authors.affiliation: School of Nursing, Chang Gung University, Taoyuan, Taiwan. Electronic address: sttang@mail.cgu.edu.tw.
authors.forename: Siew Tzuh
authors.initials: ST
authors.lastname: Tang
authors.affiliation: Department of International Business, Soochow University, Taipei, Taiwan.
authors.forename: Fur-Hsing
authors.initials: FH
authors.lastname: Wen
authors.affiliation: Division of Hematology-Oncology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Chia-Hsun
authors.initials: CH
authors.lastname: Hsieh
authors.affiliation: Division of Hematology-Oncology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Wen-Chi
authors.initials: WC
authors.lastname: Chou
authors.affiliation: Division of Hematology-Oncology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Wen-Cheng
authors.initials: WC
authors.lastname: Chang
authors.affiliation: Division of Hematology-Oncology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Jen-Shi
authors.initials: JS
authors.lastname: Chen
authors.affiliation: Department of Nursing, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
authors.forename: Ming-Chu
authors.initials: MC
authors.lastname: Chiang
mesh_terms: D000328:Adult; D000368:Aged; D001364:Awareness; D003863:Depression; D018450:Disease Progression; D005260:Female; D006801:Humans; D008020:Life Support Care / Q000379:methods / Q000523:psychology*; D016014:Linear Models; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D057240:Patient Preference / Q000523:psychology*; D011379:Prognosis; D013624:Taiwan; D013727:Terminal Care / Q000379:methods / Q000523:psychology*; D019452:Terminally Ill / Q000523:psychology*; D016312:Treatment Refusal / Q000523:psychology
keywords: Preferences; end-of-life care; life-sustaining treatments; stability; terminally ill cancer patients