Patients can improve the quality of their dying by preparing for the end of life and their impending death. For a study, researchers sought to determine the never-before-seen relationships between cancer patients’ death-preparedness states and psychological distress, quality of life (QOL), and end-of-life care. In the cohort study, they used multivariate hierarchical linear modeling and logistic regression models to examine the associations of four previously identified death-preparedness states (no-death-preparedness, cognitive-death-preparedness-only, emotional-death-preparedness-only, and sufficient-death-preparedness states) with anxiety symptoms, depressive symptoms, and QOL over 383 cancer patients’ last six months and end-of-life care received in the last month. Minimal clinically significant differences (MCIDs) for anxiety- (1.3–1.8) and depressive- (1.5–1.7) symptom subscales (0–21 Likert scales) have been defined.
Patients in the no-death-preparedness and cognitive-death-preparedness-only conditions reported anxiety and depression symptoms that exceeded the MCIDs, as well as a decrease in QOL compared to those in the sufficient-death-preparedness state. Patients in the emotional-death-preparedness-only condition were more likely (OR [95% CI]=2.38 [1.14, 4.97]) and less likely (OR [95% CI]=0.38 [0.15, 0.94]) than those in the sufficient-death-preparedness state to receive chemotherapy/immunotherapy and hospice care, respectively. Death-preparation phases were not related to recent life-sustaining interventions.
Conjoint cognitive and emotional readiness for death was linked to lower psychological distress, improved QOL, reduced anti-cancer medication, and more significant hospice-care usage in cancer patients. When congruent with the patient’s circumstances and desires, facilitating accurate prognostic awareness and emotional readiness for death was appropriate.