Prognostic Disclosure, End-of-Life Communication, and Social Support Associated With Distinct Dyadic...

Preparing for death is relational because patients with advanced cancer and family caregivers confront approaching death together. We examined individual and relational factors associated with distinct dyadic death-preparedness states during patients' final six months of life.

In this longitudinal cohort study of 694 patient-caregiver dyads, hierarchical generalized linear models with lagged time-varying predictors examined unprepared-concordant, cognitive-concordant, emotional-concordant, and sufficient-concordant states versus discordance across individual, relationship, and relationship-process domains.

Older patient age was associated with lower likelihood of cognitive concordance but higher likelihood of sufficient concordance, and higher patient educational attainment was associated with sufficient concordance. Patient- and caregiver-reported physician prognostic disclosure was associated with higher likelihoods of cognitive concordance (AORs, 3.416 and 2.411, respectively) and sufficient concordance (AORs, 3.743 and 2.854, respectively). Greater patient-reported end-of-life discussions with caregivers were associated with a higher likelihood of cognitive concordance (AOR, 1.190; 95% CI, 1.106-1.279) but a lower likelihood of emotional concordance (AOR, 0.800; 95% CI, 0.650-0.985). Higher patient- and caregiver-reported social support was associated with a lower likelihood of cognitive concordance (AORs, 0.956 and 0.945, respectively).

Relationship-process factors were more consistently associated with dyadic death-preparedness states than individual or relationship characteristics. These findings support assessing both patients' and caregivers' cognitive and emotional preparedness and considering reported prognostic disclosure, patient-caregiver end-of-life discussions, and social-support dynamics when evaluating dyadic preparation for death.