Half of advanced cancer patients do not have accurate prognostic awareness (PA). However, few randomized clinical trials (RCTs) have focused on facilitating these patients’ PA to reduce their life-sustaining treatments (LSTs) at end of life.
A blinded RCT was conducted for terminally ill cancer patients with internal validity enhanced by concealing arm allocation, blinding participants and data collectors, and ensuring treatment fidelity. The experimental-arm received an interactive intervention tailored to their readiness for prognostic information. The control-arm received a sham symptom-management educational treatment. Effectiveness of the intervention in facilitating accurate PA and reducing LSTs received was evaluated by intention-to-treat analysis using multivariate logistic regression, specifically by modeling “arm by time proximity to death” with the generalized estimating equation and “arm by accurate PA” interactions, respectively.
Participants (N = 460) were randomly assigned 1:1 to experimental and control arms, each with 215 participants in the final sample. With reference to 151-180 days before death, the experimental-arm had significantly higher odds of accurate PA than the control-arm 61-90, 91-120, and 121-150 days before death (AOR [95% CI]: 1.94 [1.10-3.40], 1.89 [1.06-3.36], and 1.98 [1.19-3.28], respectively) but not 1-60 days before death. Experimental-arm participants with accurate PA were significantly less likely than control-arm participants without accurate PA to receive cardiopulmonary resuscitation (CPR) (0.16 [0.03-0.73]), but not less likely to receive other LSTs (including intensive care unit care and mechanical ventilation) in their last month.
Our intervention facilitated participants’ accurate PA early in their terminal-illness trajectory, thereby reducing their risk of receiving CPR in their last month and avoiding suffering from futile LSTs.
Chang Gung University.
National Health Research Institutes (NHRI-EX106-10208PI), Ministry of Science and Technology (MOST 104-2314-B-182-027-MY3), Chang Gung Memorial Hospital (BMRP888).
All authors have declared no conflicts of interest.