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Background/Purpose <p>Interventions to reduce potentially nonbeneficial aggressive end-of-life (EOL) care remain limited. Patient-caregiver concordance on death preparedness may offer a novel approach to improving EOL care but remains understudied. This study examined associations between such concordance and EOL care in cancer patients’ final months.</p> Methods <p>In this cohort study, associations between last-assessed dyadic-concordance death-preparedness groups (unprepared-concordant, cognitive-concordant, emotional-concordant, and sufficient-concordant vs discordant) and receipt of chemotherapy, life-sustaining treatments (LSTs) (e.g., cardiopulmonary resuscitation (CPR), ICU care, intubation, mechanical ventilation, vasopressors), nasogastric feeding, and hospice care were examined using logistic regression among 694 dyads of cancer patients and their primary family caregivers.</p> Results <p>Membership in the sufficient-concordant death-preparedness state was associated with a lower likelihood of receiving chemotherapy (adjusted odds ratio [95% confidence interval] = 0.55 [0.31, 0.95]), intubation (0.30 [0.11, 0.83]), and mechanical ventilation (0.27 [0.09, 0.82]) and a higher likelihood of hospice care (1.97 [1.08, 3.60]). In contrast, membership in the unprepared-concordant death-preparedness state was associated with a higher likelihood of CPR (35.28 [3.65, 340.77]), intubation (8.38 [1.14, 61.45]), and mechanical ventilation (8.33 [1.11, 62.38]), and a lower likelihood of hospice care (0.05 [0.01, 0.49]). Patients in cognitive- or sufficient-concordant states were less likely to receive nasogastric feeding (0.59 [0.37, 0.94] and 0.58 [0.36, 0.95], respectively).</p> Conclusions <p>Dyadic death-preparedness concordance was significantly associated with chemotherapy, aggressive LSTs, nasogastric feeding in the last month, and hospice care at EOL. Supporting open communication to facilitate and align patient-caregiver preparedness may improve EOL care; however, further research is needed to evaluate the effectiveness of such approaches.</p> Graphical Abstract <p></p>

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Dyadic-concordance death-preparedness states and end-of-life care received by cancer patients

  • 期刊论文

  • 发表日期：

    2026年4月23日

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  • Fur-Hsing Wen,
  • Chia-Hsun Hsieh,
  • Jen-Shi Chen,
  • Wen-Cheng Chang,
  • Wen-Chi Chou,
  • Siew Tzuh Tang

摘要

Background/Purpose

Interventions to reduce potentially nonbeneficial aggressive end-of-life (EOL) care remain limited. Patient-caregiver concordance on death preparedness may offer a novel approach to improving EOL care but remains understudied. This study examined associations between such concordance and EOL care in cancer patients’ final months.

Methods

In this cohort study, associations between last-assessed dyadic-concordance death-preparedness groups (unprepared-concordant, cognitive-concordant, emotional-concordant, and sufficient-concordant vs discordant) and receipt of chemotherapy, life-sustaining treatments (LSTs) (e.g., cardiopulmonary resuscitation (CPR), ICU care, intubation, mechanical ventilation, vasopressors), nasogastric feeding, and hospice care were examined using logistic regression among 694 dyads of cancer patients and their primary family caregivers.

Results

Membership in the sufficient-concordant death-preparedness state was associated with a lower likelihood of receiving chemotherapy (adjusted odds ratio [95% confidence interval] = 0.55 [0.31, 0.95]), intubation (0.30 [0.11, 0.83]), and mechanical ventilation (0.27 [0.09, 0.82]) and a higher likelihood of hospice care (1.97 [1.08, 3.60]). In contrast, membership in the unprepared-concordant death-preparedness state was associated with a higher likelihood of CPR (35.28 [3.65, 340.77]), intubation (8.38 [1.14, 61.45]), and mechanical ventilation (8.33 [1.11, 62.38]), and a lower likelihood of hospice care (0.05 [0.01, 0.49]). Patients in cognitive- or sufficient-concordant states were less likely to receive nasogastric feeding (0.59 [0.37, 0.94] and 0.58 [0.36, 0.95], respectively).

Conclusions

Dyadic death-preparedness concordance was significantly associated with chemotherapy, aggressive LSTs, nasogastric feeding in the last month, and hospice care at EOL. Supporting open communication to facilitate and align patient-caregiver preparedness may improve EOL care; however, further research is needed to evaluate the effectiveness of such approaches.

Graphical Abstract