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Quality of life changes and intensive care preferences in terminal cancer patients

Published online by Cambridge University Press:  07 November 2014

In Cheol Hwang ,
Bhumsuk Keam ,
Young Ho Yun ,
Hong Yup Ahn  and
Young-Ae Kim
In Cheol Hwang
Affiliation:
Department of Family Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
Bhumsuk Keam
Affiliation:
Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
Young Ho Yun*
Affiliation:
Cancer Research Institute and Department of Biomedical Science, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
Hong Yup Ahn
Affiliation:
Department of Statistics, Dongguk University, Seoul, Republic of Korea
Young-Ae Kim
Affiliation:
Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
*
Address correspondence and reprint requests to: Young Ho Yun, Department of Biomedical Science, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 110-799, Republic of Korea. E-mail: lawyun@snu.ac.kr.
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Abstract

Objective:

There is scarce research on the short-term fluctuations in end-of-life (EoL) care planning for seriously ill patients. The aim of our study was to investigate the stability of preferences regarding treatment in an intensive care unit (ICU) and identify the factors associated with changes in preferences in terms of quality of life (QoL).

Method:

A prospective examination on preference changes for ICU care in 141 terminal cancer patients was conducted. Patients were categorized according to their change in preference during the final two months of their lives into four categories: (1) the keep–accept group, (2) the keep–reject group, (3) the change to accept group, and (4) the change to reject group. Using multiple logistic analyses, we explored the association between patient demographics, health-related QoL, and changes in ICU preference.

Results:

The overall stability of ICU preferences near the end of life was 66.7% (κ = 0.33, p < 0.001). Married patients were more likely to change their preference regarding ICU care [adjusted odds ratio (aOR) toward accept 12.35, p = 0.021; aOR toward reject 10.56, p = 0.020] than unmarried patients. Patients with stable physical function tended to accept ICU care (aOR = 5.05, p = 0.023), whereas those with poor performance (aOR = 5.32, p = 0.018), worsened QoL (aOR = 8.34, p = 0.007), or non-aggravated fatigue (aOR = 8.36, p = 0.006) were more likely to not accept ICU care.

Significance of results:

The attitudes of terminally ill cancer patients regarding ICU care at the end of life were not stable over time, and changes in their QoL were associated with a tendency to change their preferences about ICU care. Attention should thus be paid to patients' QoL changes to improve medical decision making with regard to EoL care.

Keywords

ChangesIntensive care unitPreferenceQuality of lifeTerminal care
Type
Original Articles
Information
Palliative & Supportive Care , Volume 13 , Issue 5 , October 2015 , pp. 1309 - 1316
Copyright
Copyright © Cambridge University Press 2014 

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References

REFERENCES

Aaronson, N.K., Ahmedzai, S., Bergman, B., et al. (1993). The European Organization for Research and Treatment of Cancer QLQ–C30: A quality-of-life instrument for use in international clinical trials in oncology. Journal of the National Cancer Institute, 85(5), 365–376.CrossRefGoogle ScholarPubMed
Barrio-Cantalejo, I.M., Simon-Lorda, P., Molina-Ruiz, A., et al. (2013). Stability over time in the preferences of older persons for life-sustaining treatment. Journal of Bioethical Inquiry, 10(1), 103–114.Google Scholar
Cooke, C.R., Feemster, L.C., Wiener, R.S., et al. (2014). Aggressiveness of intensive care use among patients with lung cancer in the SEER–Medicare registry. Chest, 146(4), 916–923.CrossRefGoogle Scholar
Cotter, P.E., Simon, M., Quinn, C., et al. (2009). Changing attitudes to cardiopulmonary resuscitation in older people: A 15-year follow-up study. Age and Ageing, 38(2), 200–205.CrossRefGoogle ScholarPubMed
Danis, M., Garrett, J., Harris, R., et al. (1994). Stability of choices about life-sustaining treatments. Annals of Internal Medicine, 120(7), 567–573.Google Scholar
Ditto, P.H., Jacobson, J.A., Smucker, W.D., et al. (2006). Context changes choices: A prospective study of the effects of hospitalization on life-sustaining treatment preferences. Medical Decision Making, 26(4), 313–322.CrossRefGoogle ScholarPubMed
Earle, C.C., Landrum, M.B., Souza, J.M., et al. (2008). Aggressiveness of cancer care near the end of life: Is it a quality-of-care issue? Journal of Clinical Oncology, 26(23), 3860–3866.Google Scholar
Erci, B. & Ozdemir, S. (2009). Predictors of treatment decision evaluation in patients with cancer. Psycho-Oncology, 18(7), 700–707.Google Scholar
Everhart, M.A. & Pearlman, R.A. (1990). Stability of patient preferences regarding life-sustaining treatments. Chest, 97(1), 159–164.Google Scholar
Fried, T.R., Byers, A.L., Gallo, W.T., et al. (2006). Prospective study of health status preferences and changes in preferences over time in older adults. Archives of Internal Medcine, 166(8), 890–895.Google Scholar
Fried, T.R., Van Ness, P.H., Byers, A.L., et al. (2007). Changes in preferences for life-sustaining treatment among older persons with advanced illness. Journal of General Internal Medicine, 22(4), 495–501.CrossRefGoogle ScholarPubMed
Ho, T.H., Barbera, L., Saskin, R., et al. (2011). Trends in the aggressiveness of end-of-life cancer care in the universal health care system of Ontario, Canada. Journal of Clinical Oncology, 29(12), 1587–1591.Google Scholar
Janssen, D.J., Spruit, M.A., Schols, J.M., et al. (2012). Predicting changes in preferences for life-sustaining treatment among patients with advanced chronic organ failure. Chest, 141(5), 1251–1259.Google Scholar
Kim, Y.J., Kim, M.J., Cho, Y.J., et al. (2014). Who should be admitted to the intensive care unit? The outcome of intensive care unit admission in stage IIIB–IV lung cancer patients. Medical Oncology, 31(3), 847.CrossRefGoogle Scholar
Kwak, J. & Salmon, J.R. (2007). Attitudes and preferences of Korean-American older adults and caregivers on end-of-life care. Journal of the American Geriatrics Society, 55(11), 1867–1872.Google Scholar
Mack, J.W., Weeks, J.C., Wright, A.A., et al. (2010). End-of-life discussions, goal attainment, and distress at the end of life: Predictors and outcomes of receipt of care consistent with preferences. Journal of Clinical Oncology, 28(7), 1203–1208.Google Scholar
Mack, J.W., Cronin, A., Keating, N.L., et al. (2012). Associations between end-of-life discussion characteristics and care received near death: A prospective cohort study. Journal of Clinical Oncology, 30(35), 4387–4395.Google Scholar
McParland, E., Likourezos, A., Chichin, E., et al. (2003). Stability of preferences regarding life-sustaining treatment: A two-year prospective study of nursing home residents. The Mount Sinai Journal of Medicine, New York, 70(2), 85–92.Google Scholar
Mo, H.N., Shin, D.W., Woo, J.H., et al. (2012). Is patient autonomy a critical determinant of quality of life in Korea? End-of-life decision making from the perspective of the patient. Palliative Medicine, 26(3), 222–231.Google Scholar
Mukamel, D.B., Ladd, H. & Temkin-Greener, H. (2013). Stability of cardiopulmonary resuscitation and do-not-resuscitate orders among long-term nursing home residents. Medical Care, 51(8), 666–672.CrossRefGoogle ScholarPubMed
Nielsen, B.K., Mehlsen, M., Jensen, A.B., et al. (2013). Cancer-related self-efficacy following a consultation with an oncologist. Psycho-Oncology, 22(9), 2095–2101.CrossRefGoogle ScholarPubMed
Oken, M.M., Creech, R.H., Tormey, D.C., et al. (1982). Toxicity and response criteria of the Eastern Cooperative Oncology Group. American Journal of Clinical Oncology, 5(6), 649–655.CrossRefGoogle ScholarPubMed
Osoba, D., Rodrigues, G., Myles, J., et al. (1998). Interpreting the significance of changes in health-related quality-of-life scores. Journal of Clinical Oncology, 16(1), 139–144.Google Scholar
Peppercorn, J.M., Smith, T.J., Helft, P.R., et al. (2011). American society of clinical oncology statement: Toward individualized care for patients with advanced cancer. Journal of Clinical Oncology, 29(6), 755–760.Google Scholar
Rosenfeld, K.E., Wenger, N.S., Phillips, R.S., et al. (1996). Factors associated with change in resuscitation preference of seriously ill patients: The SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. Archives of Internal Medicine, 156(14), 1558–1564.Google Scholar
Smith, T.J., Temin, S., Alesi, E.R., et al. (2012). American Society of Clinical Oncology provisional clinical opinion: The integration of palliative care into standard oncology care. Journal of Clinical Oncology, 30(8), 880–887.Google Scholar
Straton, J.B., Wang, N.Y., Meoni, L.A., et al. (2004). Physical functioning, depression, and preferences for treatment at the end of life: The Johns Hopkins Precursors Study. Journal of the American Geriatrics Society, 52(4), 577–582.Google Scholar
Weeks, J.C., Cook, E.F., O'Day, , et al. (1998). Relationship between cancer patients' predictions of prognosis and their treatment preferences. The Journal of the American Medical Association, 279(21), 1709–1714.CrossRefGoogle ScholarPubMed
Weissman, J.S., Haas, J.S., Fowler, F.J. Jr., , et al. (1999). The stability of preferences for life-sustaining care among persons with AIDS in the Boston Health Study. Medical Decision Making, 19(1), 16–26.CrossRefGoogle ScholarPubMed
Wittink, M.N., Morales, K.H., Meoni, L.A., et al. (2008). Stability of preferences for end-of-life treatment after 3 years of follow-up: The Johns Hopkins Precursors Study. Archives of Internal Medicine, 168(19), 2125–2130.Google Scholar
Wright, A.A., Zhang, B., Ray, A., et al. (2008). Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. The Journal of the American Medical Association, 300(14), 1665–1673.CrossRefGoogle ScholarPubMed
Wright, A.A., Keating, N.L., Balboni, T.A., et al. (2010). Place of death: Correlations with quality of life of patients with cancer and predictors of bereaved caregivers' mental health. Journal of Clinical Oncology, 28(29), 4457–4464.Google Scholar
Yun, Y.H., Park, Y.S., Lee, E.S., et al. (2004). Validation of the Korean version of the EORTC QLQ–C30. Quality of Life Research, 13(4), 863–868.CrossRefGoogle ScholarPubMed
Yun, Y.H., Kwon, Y.C., Lee, M.K., et al. (2010 a). Experiences and attitudes of patients with terminal cancer and their family caregivers toward the disclosure of terminal illness. Journal of Clinical Oncology, 28(11), 1950–1957.Google Scholar
Yun, Y.H., Lee, M.K., Chang, Y.J., et al. (2010 b). The life-sustaining treatments among cancer patients at end of life and the caregiver's experience and perspectives. Supportive Care in Cancer, 18(2), 189–196.Google Scholar
Yun, Y.H., Lee, M.K., Kim, S.Y., et al. (2011). Impact of awareness of terminal illness and use of palliative care or intensive care unit on the survival of terminally ill patients with cancer: Prospective cohort study. Journal of Clinical Oncology, 29(18), 2474–2480.Google Scholar