CN18 Promoting acceptance and execution of advanced directives: A retrospective review in a regional hospice center in Hong Kong

Abstract

Background: Accurate prognostic awareness (PA) is essential for cancer patients to make informed end-of-life care plans. However, patients may not homogeneously develop accurate PA, and predictors of PA transition patterns have never been studied. We aimed to identify PA transition patterns and their predictors over cancer patients' last 6 months.Methods: PA was categorized into four states: (1) unknown and not wanting to know;(2) unknown but wanting to know; (3) inaccurate awareness; and (4) accurate awareness. Change patterns in PA states were identified by examining the first and last estimations by multistate Markov modeling during 332 cancer patients' last 6 months. Predictors of patients' distinct PA transition patterns were determined by multinomial logistic regression focused on lagged modifiable time-varying independent variables.Results: We identified four change patterns in PA states: maintaining accurate PA (56.6%), gaining accurate PA (20.5%), still wanting but inaccurate PA (7.2%), and still not wanting to know PA (15.7%). Physicians were more likely to disclose prognosis to the maintaining-accurate-PA group than other groups. Patients with more anxiety symptoms were less likely to be in the still-not-wanting to-know-PA group than in the maintaining-accurate-PA and gaining-accurate PA groups (adjusted odds ratio [95% confidence interval]¼AOR [95% CI]: 0.86 [0.76, 0.98] and 0.87 [0.76, 1.00], respectively). Patients with more social support (AOR [95% CI]: 0.94 [0.89, 0.99]) were less likely to be in the still-not-wanting to-know-PA group than in the maintaining-accurate-PA group. Patients with longer post-enrollment survival or higher educational levels were less likely to be in the still-not-wanting-to-know-PA group than in the gaining-accurate-PA group or the still-wanting but inaccurate-PA group, respectively.Conclusions: Most patients maintained or gained accurate PA before death, but about one-fourth of patients still wanted to know but had inaccurate PA or did not want to know PA. Modifiable factors like physicians' prognostic disclosure, and patients' anxiety symptoms and social support predicted distinct PA transition patterns over cancer patients' last 6 months.