Dyadic-Concordance Death-Preparedness and End-of-Life Discussions in Cancer Patients' Last 6 Months

Area of Science:

• Medical Sociology
• Palliative Care
• Health Communication

Background:

• Physician-patient end-of-life care discussions are crucial but underutilized.
• Longitudinal examination of these discussions and patient-family interdependence in death preparedness is limited.
• Patient-family interdependence in death preparedness for care planning is often overlooked.

Purpose of the Study:

• To examine changes in physician-patient/family end-of-life care discussions over a patient's final six months.
• To investigate the association between dyadic concordance on death preparedness and these discussions.
• To understand the role of patient-family interdependence in end-of-life care planning.

Main Methods:

• A cohort study involving 694 patient-dyads.
• Analysis of patient- and family-reported end-of-life care discussions (physician-patient only, physician-family only, physician-patient-and-family, or no discussions).
• Hierarchical generalized multinomial logistic regression used to examine associations with dyadic concordance states (unprepared, cognitive, emotional, sufficient, discordant).

Main Results:

• Physician discussions increased over time, shifting towards family involvement: no discussions decreased (82.8% to 41.6%), physician-family-only increased (13.8% to 35.7%), and physician-patient-and-family discussions rose (1.7% to 18.1%).
• Sufficiently concordant dyads were more likely to have physician-family-only (AOR=1.87) and physician-patient-and-family (AOR=3.09) discussions compared to discordant dyads.
• Cognitively concordant dyads were more likely to engage in physician-patient-and-family discussions (AOR=3.61) relative to no discussions.

Conclusions:

• Physician silence regarding end-of-life care decreased as death approached.
• Increased physician-family-only and physician-patient-and-family discussions were observed in the final month.
• Dyadic concordance on death preparedness is linked to discussion patterns, emphasizing the need for early physician-led discussions on prognostic awareness and emotional readiness to enhance end-of-life care planning.