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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 
 Medical Decision Making, Vol.34(6) : 720-730, 2014 
Journal Title
 Medical Decision Making 
Issue Date
Adult ; Aged ; Attitude* ; Caregivers/psychology* ; Female ; Humans ; Male ; Medical Oncology* ; Middle Aged ; Neoplasms/psychology* ; Republic of Korea ; Socioeconomic Factors ; Terminal Care/psychology* ; Terminology as Topic ; Young Adult
end of life ; life-sustaining treatment ; palliative care ; terminal cancer ; terminology
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 life-sustaining 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.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
박병우(Park, Byeong Woo) ORCID logo https://orcid.org/0000-0003-1353-2607
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