Background: Studies on factors influencing preferences for aggressive end-of-life (EOL) care have focused predominantly on preferred goals of EOL and seldom comprehensively incorporate patients’ predisposing, enabling, and need factors into their analyses.
Objective: The aim of this study was to investigate the determinants of preferences for a wide range of aggressive EOL care from the aforementioned factors.
Methods: A cross-sectional survey was conducted using a convenience sample of 2329 terminally ill cancer patients recruited from 23 hospitals throughout Taiwan.
Results: Among these Taiwanese terminally ill cancer patients, 8.2% preferred prolonging life as their goal for EOL care. When combining those who wanted and those who were undecided as wanting that specific treatment, 27.9% preferred cardiopulmonary resuscitation when their life was in danger, and 36.0%, 27.3%, 24.3%, and 26.7% preferred to receive care at intensive care unit, cardiac massage, intubation, and mechanical ventilation support, respectively. Those at risk of preferring aggressive EOL care were men, younger than 45 years, married, diagnosed within 6 months, and with comorbidity and their physician had not accurately disclosed their prognosis or discussed EOL care issues to/with them.
Conclusions: Few Taiwanese terminally ill cancer patients preferred to prolong life as their goal for EOL care, cardiopulmonary resuscitation when their life was in danger, and life-sustaining treatments at EOL. Preferences for aggressive EOL care are determined by patients’ predisposing, enabling, and need factors.
Implications for Practice: Terminally ill cancer patients at risk of preferring aggressive EOL care should receive interventions to help them appropriately weigh the burdens and benefits of such aggressive treatments.
Author Affiliations: Department of Nursing, Fu Jen Catholic University, New Taipei City, Taiwan (Dr Liu); Department of Nursing, Kang-Ning Junior College of Medical Care and Management, and School of Nursing, Chang Gung University, Tao-Yuan, Taiwan (Ms Chen); National Institute of Cancer Research, National Health Research Institutes, Taipei, Taiwan (Dr Liu); Department of Nursing, Tzu Chi University, Hualien, Taiwan (Dr Lin); Department of Nursing, National Taipei University of Nursing and Health Science, Taiwan (Dr Lee); School of Nursing, Medical College, Chang Gung University, Tao-Yuan, Taiwan (Dr Tang).
Bureau of Health Promotion, Department of Health, Taiwan (DOH 9911020C), with partial support from National Health Research Institute (NHRI-EX101-9906PI and NHRI-EX102-10208PI).
None of the funding sources had any role in designing and conducting the study; collecting, managing, analyzing, and interpreting the data; or preparing, reviewing, or approving the manuscript.
The authors have no conflicts of interest to disclose.
Correspondence: Siew T. Tang, DNSc, School of Nursing, Medical College, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan, Taiwan 333, ROC (firstname.lastname@example.org).
Accepted for publication March 1, 2014.