Conjoint cognitive and emotional death‐preparedness states and their changes within cancer patients' last 6 months

Abstract

Background/Objective Cognitive prognostic awareness (PA) and emotional preparedness for death are distinct but related concepts that have rarely been investigated conjointly and without considering the dynamic nature of death preparedness. To fill this gap, this secondary‐analysis study identified distinct patterns/states of death preparedness and their changes within cancer patients' last 6 months. Methods Distinct death‐preparedness states, determined by conjoint cognitive PA and emotional preparedness for death, as well as their changes between consecutive times were identified and estimated, respectively, by latent transition modeling with hidden Markov modeling among 383 cancer patients within their last 6 months. Results Four death‐preparedness states (prevalence) were initially identified: no death preparedness (17.1%), cognitive death preparedness only (23.3%), emotional death preparedness only (39.9%), and sufficient death preparedness (19.7%). Patients in the no‐death‐preparedness state had neither accurate PA nor adequate emotional preparedness for death. The sufficient‐death‐preparedness state was characterized by both accurate PA and adequate emotional preparedness for death. In the cognitive‐ and emotional‐death‐preparedness‐only states, patients were accurately aware of their prognosis and adequately emotionally prepared for their forthcoming death only, respectively. As death approached, state prevalence fluctuated within a narrow range for the no‐ and sufficient‐death‐preparedness states, whereas prevalence of cognitive‐ and emotional‐death‐preparedness‐only states increased and decreased substantially, respectively. Conclusion Cancer patients heterogeneously experienced conjoint cognitive PA and emotional preparedness for death, and prevalence of death‐preparedness states changed substantially as death approached. Effective interventions are warranted to cultivate cognitive PA and facilitate emotional death‐preparedness to improve end‐of‐life‐care quality, thereby helping patients achieve a good death.

Factors associated with cancer patients' distinct death‐preparedness states

“…This study is part of an ethical‐review‐committee‐approved (103‐7015B) longitudinal, observational study on death‐preparedness experiences of terminally ill cancer patients 14,22 . Detailed information for eligibility, subject recruitment, and data collection has been reported 14,22 .…”

“…Death‐preparedness states were previously identified by latent transition modeling with hidden Markov modeling as no‐preparedness, cognitive‐only, emotional‐only, and sufficient‐preparedness states 22 . State prevalence fluctuated within a narrow range in the patient's last 6 months for participants in no‐ (17.1%–16.3%) and sufficient‐preparedness (19.7%–24.9%) states.…”

“…This study is part of an ethical-review-committee-approved (103-7015B) longitudinal, observational study on death-preparedness experiences of terminally ill cancer patients. 14,22 Detailed information for eligibility, subject recruitment, and data collection has been reported. 14,22 Briefly, advanced cancer patients whose disease continually progressed and was unresponsive to repeated chemotherapy/ immunotherapy were recruited conveniently and followed from 1 August 2015 through 31 December 2019 from a northwest Taiwanese medical center.…”

“…14,22 Detailed information for eligibility, subject recruitment, and data collection has been reported. 14,22 Briefly, advanced cancer patients whose disease continually progressed and was unresponsive to repeated chemotherapy/ immunotherapy were recruited conveniently and followed from 1 August 2015 through 31 December 2019 from a northwest Taiwanese medical center. Experienced, trained oncology nurses interviewed participants face-to-face at enrollment and every 2-4 weeks until participants withdrew or died.…”

“…12 Death-preparedness states were previously identified by latent transition modeling with hidden Markov modeling as nopreparedness, cognitive-only, emotional-only, and sufficientpreparedness states. 22 -1049…”