Article

Determinants of patient-family caregiver congruence on preferred place of death in taiwan.

School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, Republic of China.
Journal of pain and symptom management (impact factor: 2.42). 08/2010; 40(2):235-45. DOI:10.1016/j.jpainsymman.2009.12.018 pp.235-45
Source: PubMed

ABSTRACT Patient-family caregiver congruence on preferred place of death not only increases the likelihood of dying at home but also contributes significantly to terminally ill cancer patients' quality of life.
To examine the determinants of patient-family caregiver congruence on the preferred place of death in Taiwan.
Patient-family caregiver dyads (n=1,108) were surveyed on preferences and needs for end-of-life (EOL) care. Determinants of congruence on preferences were identified by multivariate logistic regression.
Patient-caregiver dyads achieved 78.1% agreement on the preferred place of death. The kappa coefficient of congruence was 0.55 (95% confidence interval [CI]=0.50, 0.60). The extent of patient-family caregiver congruence on preferred place of death increased with the patient's higher functional dependence (adjusted odds ratio [AOR] and 95% CI=1.04 [1.02, 1.05]), higher patient-rated importance for dying at preferred place of death (AOR [95% CI]=1.60 [1.43, 1.79]), and having a spousal caregiver (AOR [95% CI]=1.62 [1.14, 2.31]). Other determinants of patient-family caregiver congruence included patient age (AOR [95% CI]=1.01 [1.00, 1.03]), patient-family concordance on preferred EOL care options (AOR=1.68-1.73), patient knowledge of prognosis (AOR [95% CI]=0.68 [0.48, 0.97]), and impact of caregiving on the family caregiver's life (AOR [95% CI]=0.98 [0.96, 0.99]).
Increasing patient-family congruence on preferred place of death not only requires knowledge of the patient's prognosis and advance planning by both parties but also depends on family caregivers endorsing patient preferences for EOL care options and ensuring that supporting patients dying at home does not create an intolerable burden for family caregivers.

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Keywords

advance planning
 
EOL care options
 
family caregiver's life
 
family caregivers
 
higher patient-rated importance
 
Increasing patient-family congruence
 
intolerable burden
 
odds ratio [AOR]
 
patient age
 
patient knowledge
 
patient preferences
 
patient's higher functional dependence
 
Patient-caregiver dyads
 
patient-family caregiver congruence
 
Patient-family caregiver dyads
 
patient-family concordance
 
preferred EOL care options
 
preferred place
 
spousal caregiver
 
terminally ill cancer patients' quality
 

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