Extent and determinants of terminally ill cancer patients’ concordance between preferred and received life-sustaining treatment states: an advance care planning randomized trial in Taiwan
Open accessAbstract
Context Promoting patient value-concordant end-of-life care is a priority in health care systems but has rarely been examined in randomized clinical trials. Objectives To examine the effectiveness of an advance care planning intervention in facilitating concordance between cancer patients' preferred and received life-sustaining treatment (LST) states and to explore modifiable factors facilitating or impeding such concordance. Methods Terminal cancer patients (N = 460) were randomly assigned 1:1 to the experimental and control arms of a randomized clinical trial, with 430 deceased participants comprising the final sample. States of preferred LSTs (cardiopulmonary resuscitation, intensive care unit care, chest compression, intubation with mechanical ventilation, intravenous nutrition, and nasogastric tube feeding) and LSTs received in the last month were examined by hidden Markov modeling. Concordance and its modifiable predictors were evaluated by kappa and multivariate logistic regression, respectively. Results We identified three LST-preference states (uniformly preferring LSTs, rejecting LSTs except intravenous nutrition support, and mixed LST preferences) and three received LST states (uniformly receiving LSTs, received intravenous nutrition only, and selectively receiving LSTs). Concordance was not significantly higher in the experimental than the control arm (kappa [95% CI]: 0.126 [0.032, 0.221] vs. 0.050 [-0.028, 0.128]; arm difference: odds ratio [95% CI]: 1.008 [0.675…
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In a meta-analysis of seven RCTs, a video intervention reduced the likelihood of indicating a preference for CPR relative to control.
“In a meta-analysis of seven RCTs, a video intervention reduced the likelihood of indicating a preference for CPR relative to control. 43”
From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [43]
The certainty of existing evidence has been judged most frequently as low to very low by authors of systematic reviews.
“Accordingly, the certainty of existing evidence has been judged most frequently as low to very low by authors of systematic reviews. 7 10,28,38,39,43,44,72”
From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [43]
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- Authors
- Wen, F.-H., Chen, J.-S., Chou, W.-C., Chang, W.-C., Hsieh, C.-H., & Tang, S. T.
- Affiliations
- Soochow University (TW)
- Chang Gung University (TW)
- Corresponding author
- Tang, Siew Tzuh
- Venue
- Journal of Pain and Symptom Management
- Publisher
- Elsevier BV
- Published
- 2019-07
- Volume
- 58
- Issue
- 1
- Pages
- 1-10.e10
- ISSN
- 0885-3924 (ISSN-L)
- OpenAlex
- W2936061317
- Cited by
- 17
- References
- 70
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 1 · 2023: 5 · 2022: 2 · 2021: 3 · 2020: 2
- FWCI
- 1.61
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Pain and Symptom Management (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Health Research Institutes (NHRI-EX106-10208PI)
- Ministry of Science and Technology, Taiwan (105-2314-B-182-040-MY3)
- Chang Gung Memorial Hospital, Linkou
- Chang Gung Memorial Hospital (BMRP888)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Keywords
- advance care planning, terminal cancer patients, life-sustaining treatment, end-of-life care, cardiopulmonary resuscitation, intensive care, mechanical ventilation, parenteral nutrition, nasogastric tube feeding, prognostic awareness, quality of life, depressive symptoms, anxiety symptoms, hidden Markov models
- MeSH terms
- Adult, Aged, Aged, 80 and over, Female, Humans, Life Support Care, Male, Middle Aged, Neoplasms, Quality of Life, Taiwan, Terminal Care, Terminally Ill, Advance Care Planning, Patient Preference
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