The understanding of terminal cancer and its relationship with attitudes toward end-of-life care issues

June Koo Lee, Young Ho Yun, Ah Reum An, Dae Seog Heo, Byeong Woo Park, Chi Heum Cho, Sung Kim, Dae Ho Lee, Soon Nam Lee, Eun Sook Lee, Jung Hun Kang, Si Young Kim, Jung Lim Lee, Chang Geol Lee, Yeun Keun Lim, Samyong Kim, Jong Soo Choi, Hyun Sik Jeong, Mison Chun

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Abstract

Background. Although terminal cancer is a widely used term, its meaning varies, which may lead to different attitudes toward end-of-life issues. The study was conducted to investigate differences in the understanding of terminal cancer and determine the relationship between this understanding and attitudes toward end-of-life issues. Methods. A questionnaire survey was performed between 2008 and 2009. A total of 1242 cancer patients, 1289 family caregivers, 303 oncologists from 17 hospitals, and 1006 participants from the general population responded. Results. A "6-month life expectancy" was the most common understanding of terminal cancer (45.6%), followed by "treatment refractoriness" (21.1%), "metastatic/recurrent disease" (19.4%), "survival of a few days/weeks" (11.4%), and "locally advanced disease" (2.5%). The combined proportion of "treatment refractoriness" and "6-month life expectancy" differed significantly between oncologists and the other groups combined (76.0% v. 65.9%, P = 0.0003). Multivariate analyses showed that patients and caregivers who understood terminal cancer as "survival of a few days/ weeks" showed more negative attitudes toward disclosure of terminal status compared with participants who chose "treatment refractoriness" (adjusted odds ratio [aOR] 0.42, 95% confidence interval [CI] 0.22-0.79 for patients; aOR 0.34, 95% CI 0.18-0.63 for caregivers). Caregivers who understood terminal cancer as "locally advanced" or "metastatic/ recurrent disease" showed a significantly lower percentage of agreement with withdrawal of futile lifesustaining treatment compared with those who chose "treatment refractoriness" (aOR 0.19, 95% CI 0.07-0.54 for locally advanced; aOR 0.39, 95% CI 0.21-0.72 for metastatic/recurrent). Conclusions. The understanding of terminal cancer varied among the 4 participant groups. It was associated with different preferences regarding end-of-life issues. Standardization of these terms is needed to better understand end-of-life care.

Original languageEnglish
Pages (from-to)720-730
Number of pages11
JournalMedical Decision Making
Volume34
Issue number6
DOIs
Publication statusPublished - 2014 Aug

All Science Journal Classification (ASJC) codes

  • Health Policy

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    Lee, J. K., Yun, Y. H., An, A. R., Heo, D. S., Park, B. W., Cho, C. H., Kim, S., Lee, D. H., Lee, S. N., Lee, E. S., Kang, J. H., Kim, S. Y., Lee, J. L., Lee, C. G., Lim, Y. K., Kim, S., Choi, J. S., Jeong, H. S., & Chun, M. (2014). The understanding of terminal cancer and its relationship with attitudes toward end-of-life care issues. Medical Decision Making, 34(6), 720-730. https://doi.org/10.1177/0272989X13501883