Dyadic-Concordance Death-Preparedness and End-of-Life Discussions in Cancer Patients' Last 6 Months.

Abstract

Physician-patient end-of-life care discussions are vital yet underused and rarely examined longitudinally, often overlooking patient-family interdependence in death preparedness for care planning. This cohort study examined changes in physician-patient/family discussions and their associations with dyadic concordance on death preparedness during patients' final 6 months. In 694 dyads, we examined associations between previously identified dyadic-concordance death-preparedness states (unprepared-, cognitive-, emotional-, and sufficient-concordant vs. discordant) and patient- and family-reported end-of-life-care discussions (physician-patient only, physician-family only, and physician-patient-and-family vs. no discussions) using hierarchical generalized multinomial logistic regression with discordant and no discussions as reference groups. Patients were predominantly male (75.9%; mean age 59.98 ± 10.35 years), and caregivers were mainly female spouses (79.1%, 73.5%; mean age 54.83 ± 12.40 years). Physician discussions increased over time and were largely family-centered: no discussions declined (82.8%→41.6%), physician-family-only discussions increased (13.8%→35.7%), and physician-patient-and-family discussions rose (1.7%→18.1%), while physician-patient-only discussions remained rare (1.7%→4.6%). Compared with discordant dyads, sufficient-concordant dyads were more likely to engage in physician-family-only (adjusted odds ratio [AOR]=1.87; 95% confidence interval [CI]: 1.17-2.98) and physician-patient-and-family (3.09 [1.51-6.29]) discussions, while cognitive-concordant dyads were more likely to engage in physician-patient-and-family discussions (3.61[1.82-7.18]), relative to no discussion. Physician silence decreased near death, while physician-family-only and physician-patient-and-family discussions increased in the last month. Dyadic concordance on death preparedness was associated with these patterns, underscoring the need for physicians to foster death preparedness with prognostic awareness and emotional readiness early in the terminal-illness trajectory to promote engagement in end-of-life-care planning.