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Quality of life changes and intensive care preferences in terminal cancer patients

Published online by Cambridge University Press:  07 November 2014

In Cheol Hwang ,
Bhumsuk Keam ,
Young Ho Yun ,
Hong Yup Ahn  and
Young-Ae Kim
In Cheol Hwang
Affiliation:
Department of Family Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
Bhumsuk Keam
Affiliation:
Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
Young Ho Yun*
Affiliation:
Cancer Research Institute and Department of Biomedical Science, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
Hong Yup Ahn
Affiliation:
Department of Statistics, Dongguk University, Seoul, Republic of Korea
Young-Ae Kim
Affiliation:
Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
*
Address correspondence and reprint requests to: Young Ho Yun, Department of Biomedical Science, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 110-799, Republic of Korea. E-mail: lawyun@snu.ac.kr.
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Abstract

Objective:

There is scarce research on the short-term fluctuations in end-of-life (EoL) care planning for seriously ill patients. The aim of our study was to investigate the stability of preferences regarding treatment in an intensive care unit (ICU) and identify the factors associated with changes in preferences in terms of quality of life (QoL).

Method:

A prospective examination on preference changes for ICU care in 141 terminal cancer patients was conducted. Patients were categorized according to their change in preference during the final two months of their lives into four categories: (1) the keep–accept group, (2) the keep–reject group, (3) the change to accept group, and (4) the change to reject group. Using multiple logistic analyses, we explored the association between patient demographics, health-related QoL, and changes in ICU preference.

Results:

The overall stability of ICU preferences near the end of life was 66.7% (κ = 0.33, p < 0.001). Married patients were more likely to change their preference regarding ICU care [adjusted odds ratio (aOR) toward accept 12.35, p = 0.021; aOR toward reject 10.56, p = 0.020] than unmarried patients. Patients with stable physical function tended to accept ICU care (aOR = 5.05, p = 0.023), whereas those with poor performance (aOR = 5.32, p = 0.018), worsened QoL (aOR = 8.34, p = 0.007), or non-aggravated fatigue (aOR = 8.36, p = 0.006) were more likely to not accept ICU care.

Significance of results:

The attitudes of terminally ill cancer patients regarding ICU care at the end of life were not stable over time, and changes in their QoL were associated with a tendency to change their preferences about ICU care. Attention should thus be paid to patients' QoL changes to improve medical decision making with regard to EoL care.

Keywords

ChangesIntensive care unitPreferenceQuality of lifeTerminal care
Type
Original Articles
Information
Palliative & Supportive Care , Volume 13 , Issue 5 , October 2015 , pp. 1309 - 1316
Copyright
Copyright © Cambridge University Press 2014 

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