ArticleThe journal of nursing research : JNR2025
Changes in End-of-Life Quality in Patients With Terminal Cancer During Their Last 6 Months of Life: A Longitudinal Study.
Article in The journal of nursing research : JNR, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundOptimizing end-of-life (EOL) quality is crucial for patients with cancer. However, most studies in the literature explore EOL quality in the last month of life for these patients and use retrospective investigations based on information from bereaved family caregivers. PURPOSE: In this study, the authors aimed to investigate the underexplored changes in EOL quality perceived by patients with cancer during their last 6 months of life.
methodsA longitudinal approach was used to investigate a convenience sample of 229 patients recruited at 2 medical centers in northern Taiwan from January 2020 to July 2023. The Quality of Dying and Death Questionnaire was used to measure EOL quality, and changes in EOL quality were analyzed using multivariate generalized estimating equations.
resultsAs the participants approached their terminal stage, EOL-quality total scores gradually declined (from 71.41±7.56 to 65.27±10.04), and the proportion of scores classified as "good to almost perfect" (i.e., ≥70) declined from 68.6% to 34.6% over the same period. After controlling for covariates, EOL-quality subdomains and total scores exhibited variable trends, with total EOL-quality scores significantly lower in the last 2 months than in the 91-180 days before death. In terms of the subdomains, "symptoms and personal control" had the lowest average scores and substantially decreased over the last 3 months, while scores for "death preparation" (the second-lowest), "time with family," and "whole-person concerns" significantly declined over the last 1 or 2 months, with similar patterns observed in the proportion of scores categorized as "good to almost perfect." Treatment preferences remained unchanged. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Based on the findings, different aspects of EOL quality decline at different rates as patients approach death. In terms of the most poorly rated subdimensions, "symptoms and personal control" exhibited a substantial and accelerating decrease across the 6 months before death, while "death preparation" exhibited a gradual decline close to death only. Health care professionals should prioritize symptom management and death preparation for patients with terminal cancer by carefully assessing and promptly identifying their needs and developing effective, individualized care plans.
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