title: A Decade of Changes in Preferences for Life-Sustaining Treatments Among Terminally Ill Patients With Cancer.
abstract: BACKGROUND
  Changes over time in preferences for life-sustaining treatments (LSTs) at end of life (EOL) in different patient cohorts are not well established, nor is the concept that LST preferences represent more than 2 groups (uniformly prefer/not prefer).
  
  
  OBJECTIVE
  The purpose of this study was to explore heterogeneity and changes in patterns of LST preferences among 2 independent cohorts of terminally ill patients with cancer recruited a decade apart.
  
  
  METHODS
  Preferences for cardiopulmonary resuscitation, intensive care unit care, cardiac massage, intubation with mechanical ventilation, intravenous nutritional support, nasogastric tube feeding, and dialysis were surveyed among 2,187 and 2,166 patients in 2003-2004 and 2011-2012, respectively. Patterns and changes in LST preferences were examined by multigroup latent class analysis.
  
  
  RESULTS
  We identified 7 preference classes: uniformly preferring, uniformly rejecting, uniformly uncertain, favoring nutritional support but rejecting other treatments, favoring nutritional support but uncertain about other treatments, favoring intravenous nutritional support with mixed rejection of or uncertainty about other treatments, and preferring LSTs except intubation with mechanical ventilation. Probability of class membership decreased significantly over time for the uniformly preferring class (15.26%-8.71%); remained largely unchanged for the classes of uniformly rejecting (41.71%-40.54%) and uniformly uncertain (9.10%-10.47%), and favoring nutritional support but rejecting (20.68%-21.91%) or uncertain about (7.02%-5.47%) other treatments, and increased significantly for the other 2 classes. The LST preferences of Taiwanese terminally ill patients with cancer are not a homogeneous construct and shifted toward less-aggressive treatments over the past decade.
  
  
  CONCLUSIONS
  Identifying LST preference patterns and tailoring interventions to the unique needs of patients in each LST preference class may lead to the provision of less-aggressive EOL care.
authors.affiliation: From Chang Gung University, School of Nursing, Taipei, Taiwan; National Institute of Cancer Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan; Department of International Business, Soochow University, Taipei, Taiwan; Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Division of Hematology-Oncology, Department of Internal Medicine, Taipei City Hospital, Ren'ai Branch, Taipei, Taiwan; Division of Hemato-Oncology, Department of Internal Medicine, Changhua Christian Hospital, Changhua City, Changhua County, Tawian; Division of Hematology-Oncology Department of Medicine, Cathay General Hospital, Taipei, Taiwan; Division of Hematology and Oncology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Department of Hemato-oncology, Taipei Tzu Chi General Hospital, Taipei, Taiwan; Department of Nursing, Fu Jen Catholic University, Taipei, Taiwan; and Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Taiwan.
authors.forename: Siew Tzuh
authors.initials: ST
authors.lastname: Tang
authors.affiliation: From Chang Gung University, School of Nursing, Taipei, Taiwan; National Institute of Cancer Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan; Department of International Business, Soochow University, Taipei, Taiwan; Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Division of Hematology-Oncology, Department of Internal Medicine, Taipei City Hospital, Ren'ai Branch, Taipei, Taiwan; Division of Hemato-Oncology, Department of Internal Medicine, Changhua Christian Hospital, Changhua City, Changhua County, Tawian; Division of Hematology-Oncology Department of Medicine, Cathay General Hospital, Taipei, Taiwan; Division of Hematology and Oncology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Department of Hemato-oncology, Taipei Tzu Chi General Hospital, Taipei, Taiwan; Department of Nursing, Fu Jen Catholic University, Taipei, Taiwan; and Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Taiwan.
authors.forename: Tsang-Wu
authors.initials: TW
authors.lastname: Liu
authors.affiliation: From Chang Gung University, School of Nursing, Taipei, Taiwan; National Institute of Cancer Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan; Department of International Business, Soochow University, Taipei, Taiwan; Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Division of Hematology-Oncology, Department of Internal Medicine, Taipei City Hospital, Ren'ai Branch, Taipei, Taiwan; Division of Hemato-Oncology, Department of Internal Medicine, Changhua Christian Hospital, Changhua City, Changhua County, Tawian; Division of Hematology-Oncology Department of Medicine, Cathay General Hospital, Taipei, Taiwan; Division of Hematology and Oncology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Department of Hemato-oncology, Taipei Tzu Chi General Hospital, Taipei, Taiwan; Department of Nursing, Fu Jen Catholic University, Taipei, Taiwan; and Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Taiwan.
authors.forename: Fur-Hsing
authors.initials: FH
authors.lastname: Wen
authors.affiliation: From Chang Gung University, School of Nursing, Taipei, Taiwan; National Institute of Cancer Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan; Department of International Business, Soochow University, Taipei, Taiwan; Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Division of Hematology-Oncology, Department of Internal Medicine, Taipei City Hospital, Ren'ai Branch, Taipei, Taiwan; Division of Hemato-Oncology, Department of Internal Medicine, Changhua Christian Hospital, Changhua City, Changhua County, Tawian; Division of Hematology-Oncology Department of Medicine, Cathay General Hospital, Taipei, Taiwan; Division of Hematology and Oncology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Department of Hemato-oncology, Taipei Tzu Chi General Hospital, Taipei, Taiwan; Department of Nursing, Fu Jen Catholic University, Taipei, Taiwan; and Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Taiwan.
authors.forename: Chiun
authors.initials: C
authors.lastname: Hsu
authors.affiliation: From Chang Gung University, School of Nursing, Taipei, Taiwan; National Institute of Cancer Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan; Department of International Business, Soochow University, Taipei, Taiwan; Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Division of Hematology-Oncology, Department of Internal Medicine, Taipei City Hospital, Ren'ai Branch, Taipei, Taiwan; Division of Hemato-Oncology, Department of Internal Medicine, Changhua Christian Hospital, Changhua City, Changhua County, Tawian; Division of Hematology-Oncology Department of Medicine, Cathay General Hospital, Taipei, Taiwan; Division of Hematology and Oncology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Department of Hemato-oncology, Taipei Tzu Chi General Hospital, Taipei, Taiwan; Department of Nursing, Fu Jen Catholic University, Taipei, Taiwan; and Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Taiwan.
authors.forename: Yi-Heng
authors.initials: YH
authors.lastname: Chang
authors.affiliation: From Chang Gung University, School of Nursing, Taipei, Taiwan; National Institute of Cancer Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan; Department of International Business, Soochow University, Taipei, Taiwan; Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Division of Hematology-Oncology, Department of Internal Medicine, Taipei City Hospital, Ren'ai Branch, Taipei, Taiwan; Division of Hemato-Oncology, Department of Internal Medicine, Changhua Christian Hospital, Changhua City, Changhua County, Tawian; Division of Hematology-Oncology Department of Medicine, Cathay General Hospital, Taipei, Taiwan; Division of Hematology and Oncology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Department of Hemato-oncology, Taipei Tzu Chi General Hospital, Taipei, Taiwan; Department of Nursing, Fu Jen Catholic University, Taipei, Taiwan; and Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Taiwan.
authors.forename: Cheng-Shyong
authors.initials: CS
authors.lastname: Chang
authors.affiliation: From Chang Gung University, School of Nursing, Taipei, Taiwan; National Institute of Cancer Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan; Department of International Business, Soochow University, Taipei, Taiwan; Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Division of Hematology-Oncology, Department of Internal Medicine, Taipei City Hospital, Ren'ai Branch, Taipei, Taiwan; Division of Hemato-Oncology, Department of Internal Medicine, Changhua Christian Hospital, Changhua City, Changhua County, Tawian; Division of Hematology-Oncology Department of Medicine, Cathay General Hospital, Taipei, Taiwan; Division of Hematology and Oncology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Department of Hemato-oncology, Taipei Tzu Chi General Hospital, Taipei, Taiwan; Department of Nursing, Fu Jen Catholic University, Taipei, Taiwan; and Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Taiwan.
authors.forename: Yung-Chuan
authors.initials: YC
authors.lastname: Sung
authors.affiliation: From Chang Gung University, School of Nursing, Taipei, Taiwan; National Institute of Cancer Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan; Department of International Business, Soochow University, Taipei, Taiwan; Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Division of Hematology-Oncology, Department of Internal Medicine, Taipei City Hospital, Ren'ai Branch, Taipei, Taiwan; Division of Hemato-Oncology, Department of Internal Medicine, Changhua Christian Hospital, Changhua City, Changhua County, Tawian; Division of Hematology-Oncology Department of Medicine, Cathay General Hospital, Taipei, Taiwan; Division of Hematology and Oncology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Department of Hemato-oncology, Taipei Tzu Chi General Hospital, Taipei, Taiwan; Department of Nursing, Fu Jen Catholic University, Taipei, Taiwan; and Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Taiwan.
authors.forename: Cheng-I
authors.initials: CI
authors.lastname: Hsieh
authors.affiliation: From Chang Gung University, School of Nursing, Taipei, Taiwan; National Institute of Cancer Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan; Department of International Business, Soochow University, Taipei, Taiwan; Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Division of Hematology-Oncology, Department of Internal Medicine, Taipei City Hospital, Ren'ai Branch, Taipei, Taiwan; Division of Hemato-Oncology, Department of Internal Medicine, Changhua Christian Hospital, Changhua City, Changhua County, Tawian; Division of Hematology-Oncology Department of Medicine, Cathay General Hospital, Taipei, Taiwan; Division of Hematology and Oncology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Department of Hemato-oncology, Taipei Tzu Chi General Hospital, Taipei, Taiwan; Department of Nursing, Fu Jen Catholic University, Taipei, Taiwan; and Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Taiwan.
authors.forename: Shou-Yi
authors.initials: SY
authors.lastname: Chang
authors.affiliation: From Chang Gung University, School of Nursing, Taipei, Taiwan; National Institute of Cancer Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan; Department of International Business, Soochow University, Taipei, Taiwan; Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Division of Hematology-Oncology, Department of Internal Medicine, Taipei City Hospital, Ren'ai Branch, Taipei, Taiwan; Division of Hemato-Oncology, Department of Internal Medicine, Changhua Christian Hospital, Changhua City, Changhua County, Tawian; Division of Hematology-Oncology Department of Medicine, Cathay General Hospital, Taipei, Taiwan; Division of Hematology and Oncology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Department of Hemato-oncology, Taipei Tzu Chi General Hospital, Taipei, Taiwan; Department of Nursing, Fu Jen Catholic University, Taipei, Taiwan; and Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Taiwan.
authors.forename: Li Ni
authors.initials: LN
authors.lastname: Liu
authors.affiliation: From Chang Gung University, School of Nursing, Taipei, Taiwan; National Institute of Cancer Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan; Department of International Business, Soochow University, Taipei, Taiwan; Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Division of Hematology-Oncology, Department of Internal Medicine, Taipei City Hospital, Ren'ai Branch, Taipei, Taiwan; Division of Hemato-Oncology, Department of Internal Medicine, Changhua Christian Hospital, Changhua City, Changhua County, Tawian; Division of Hematology-Oncology Department of Medicine, Cathay General Hospital, Taipei, Taiwan; Division of Hematology and Oncology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Department of Hemato-oncology, Taipei Tzu Chi General Hospital, Taipei, Taiwan; Department of Nursing, Fu Jen Catholic University, Taipei, Taiwan; and Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Taiwan.
authors.forename: Ming-Chu
authors.initials: MC
authors.lastname: Chiang
mesh_terms: D003430:Cross-Sectional Studies; D006801:Humans; D008020:Life Support Care / Q000379:methods / Q000639:trends; D009369:Neoplasms / Q000453:epidemiology* / Q000628:therapy*; D057240:Patient Preference; D013624:Taiwan / Q000453:epidemiology; D013727:Terminal Care / Q000379:methods / Q000639:trends; D019452:Terminally Ill