title: A Decade of Changes in Family Caregivers' Preferences for Life-Sustaining Treatments for Terminally Ill Cancer Patients at End of Life in the Context of a Family-Oriented Society.
abstract: Temporal changes in different family caregiver cohorts' preferences for life-sustaining treatments (LSTs) at end of life (EOL) have not been examined nor have the concept of whether caregivers' LST preferences represent a homogeneous or heterogeneous construct. Furthermore, LST preferences are frequently assessed from multiple treatments, making clinical applications difficult/infeasible.
  
  
  
  To identify parsimonious patterns and changes in the pattern of LST preferences for two independent cohorts of family caregivers for terminally ill Taiwanese cancer patients.
  
  
  
  Preferences for cardiopulmonary resuscitation, intensive care unit care, cardiac massage, intubation with mechanical ventilation, intravenous nutritional support, tube feeding, and dialysis were assessed among 1617 and 2056 family caregivers in 2003-2004 and 2011-2012, respectively. Patterns and changes in LST preferences were examined by multigroup latent class analysis.
  
  
  
  Five distinct classes were identified: uniformly preferring, uniformly rejecting, uniformly uncertain, and favoring nutritional support but rejecting or uncertain about other treatments. Class probability significantly decreased from 29.3% to 23.7% for the uniformly rejecting class, remained largely unchanged for the uniformly preferring (16.9%-18.6%), and favoring nutritional support but rejecting (37.1%-37.5%) or uncertain about other treatments (8.0%-10.4%) classes, but significantly increased from 7.0% to 11.5% for the uniformly uncertain class over time.
  
  
  
  Family caregivers' LST preferences for terminally ill cancer patients are a heterogeneous construct and shifted from uniformly rejecting all LSTs toward greater uncertainty. Surrogate EOL-care decision making may be facilitated by earlier and thorough assessments of caregivers' LST preferences and tailoring interventions to the unique needs of caregivers in each class identified in this study.
authors.affiliation: Chang Gung University School of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Tao-Yuan, Taiwan, Republic of China; Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Tao-Yuan, Taiwan, Republic of China. 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: Department of Nursing, Fu Jen Catholic University, New Taipei City, Taiwan, Republic of China.
authors.forename: Li Ni
authors.initials: LN
authors.lastname: Liu
authors.affiliation: Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Tao-Yuan, Taiwan, Republic of China.
authors.forename: Ming-Chu
authors.initials: MC
authors.lastname: Chiang
authors.affiliation: School of Nursing, National Taipei University of Nursing and Health Science, Taipei City, Taiwan, Republic of China.
authors.forename: Shiuyu C K
authors.initials: SC
authors.lastname: Lee
authors.affiliation: Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Tao-Yuan, Taiwan, Republic of China.
authors.forename: Man Chun
authors.initials: MC
authors.lastname: Chou
authors.affiliation: National Institute of Cancer Research, National Health Research Institutes, Taipei, Taiwan, Republic of China.
authors.forename: Wei-Lien
authors.initials: WL
authors.lastname: Feng
authors.affiliation: Department of Nursing, Tzu Chi University, Hualien City, Taiwan, Republic of China.
authors.forename: Yu-Chuan
authors.initials: YC
authors.lastname: Lin
authors.affiliation: Chi-Mei Hospital, Chi Ali, Taiwan, Republic of China.
authors.forename: I-Ping
authors.initials: IP
authors.lastname: Liu
authors.affiliation: Chia-Yi Christian Hospital, Chiayi City, Taiwan, Republic of China.
authors.forename: Ya-Hui
authors.initials: YH
authors.lastname: Kuo
authors.affiliation: Department of Nursing, E-Da Hospital and I-Shou University, Kaohsiung City, Taiwan, Republic of China.
authors.forename: Shu Ching
authors.initials: SC
authors.lastname: Chi
authors.affiliation: School of Nursing, China Medical University, Taichung, Taiwan, Republic of China; Department of Nursing, China Medical University Hospital, Taichung, Taiwan, Republic of China.
authors.forename: Kwo C
authors.initials: KC
authors.lastname: Lee
mesh_terms: D000368:Aged; D017028:Caregivers / Q000523:psychology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D008020:Life Support Care / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality* / Q000628:therapy*; D011795:Surveys and Questionnaires; D013624:Taiwan; D013727:Terminal Care / Q000523:psychology*
keywords: Preferences; cancer; end-of-life care; family caregivers; life-sustaining treatments; oncology