Association between death literacy and life-sustaining treatment preferences in patients with advanced non-small cell...

Evidence suggests that individuals with higher death literacy levels are more capable of planning their own end-of-life care. Lung cancer has the highest mortality among all cancers; therefore, early clarification of preferences for life-sustaining treatments (LSTs) represents an important and urgent clinical concern. This study aimed to examine the association between death literacy and preferences for LSTs among patients with advanced non-small cell lung cancer (NSCLC).

This cross-sectional study included 103 patients with stage IIIB or higher NSCLC at a medical center in northern Taiwan. Data were collected using structured questionnaires that assessed patients' sociodemographic characteristics, death literacy, and life-sustaining treatment preferences. Descriptive statistics were used to summarize participant characteristics. Pearson's correlation was used to analyze associations between LST preferences and death literacy. One-way ANOVA was used to analyze differences in preferences for LSTs by tertiles of total death literacy scaled mean scores: low (≤ 5.21), moderate (> 5.21 to ≤ 6.59), and high (> 6.59).

Among the LST options, cardiopulmonary resuscitation (CPR) was rated as the least desirable, whereas antibiotic therapy was the most favored. Higher overall death literacy scores, as well as the subscales of practical, experiential, and factual knowledge in death literacy, were significantly and inversely associated with preferences for LSTs, such as antibiotics, blood transfusion, hemodialysis, nasogastric tube insertion, intubation, and CPR; this indicated a modest correlation with lower willingness to receive these treatments. In addition, compared with the low death literacy group, patients in the high death literacy group were less likely to prefer aggressive LSTs.

Patients with higher death literacy levels were less likely to prefer aggressive LSTs. This study provides an initial empirical foundation for clarifying the nature and direction of these associations. Future research with larger and more diverse samples, as well as with longitudinal designs, is warranted to examine how death literacy and treatment preferences evolve over time across different disease populations.