Caregivers’ Death-Preparedness States Impact Caregiving Outcomes and Patients’ End-of-Life Care

Fur Hsing Wen, Wen Chi Chou, Ming Mo Hou, Po Jung Su, Wen Chi Shen, Jen Shi Chen, Wen Cheng Chang, Mei Huang Hsu, Siew Tzuh Tang*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

7 Scopus citations


Background/Objective: Preparing family caregivers, cognitively, emotionally, and behaviorally, for their relative's death is an actionable component of high-quality end-of-life care. We aimed to examine the never-before-examined associations of conjoint cognitive prognostic awareness and emotional preparedness for death with caregiving outcomes and end-of-life care received by cancer patients. Design/Setting/Participants/Main measures: For this longitudinal study, associations of death-preparedness states (no-death-preparedness, cognitive-death-preparedness-only, emotional-death-preparedness-only, and sufficient-death-preparedness states) with subjective caregiving burden, depressive symptoms, and quality of life (QOL) and patients’ end-of-life care (chemotherapy and/or immunotherapy, cardiopulmonary resuscitation, intensive care unit care, intubation, mechanical ventilation support, vasopressors, nasogastric tube feeding, and hospice care) were evaluated using multivariate hierarchical linear and logistic regression modeling, respectively, for 377 caregivers in cancer patients’ last 6 months and 1 month, respectively. Key results: Caregivers in the cognitive-death-preparedness-only state experienced a higher level of subjective caregiving burden than those in the sufficient-death-preparedness state. Caregivers in the no-death-preparedness and cognitive-death-preparedness-only states reported significantly more depressive symptoms and worse QOL than those in the sufficient-death-preparedness state. Cancer patients with caregivers in the sufficient-death-preparedness state were less likely to receive chemotherapy and/or immunotherapy, intubation, mechanical ventilation, and nasogastric tube feeding than patients with caregivers in other death-preparedness states. However, patients’ receipt of hospice care was not associated with their caregivers’ death-preparedness states. Conclusion: Family caregivers’ death-preparedness states were associated with caregiving outcomes and their relative's end-of-life care. Cultivating caregivers’ accurate prognostic awareness and improving their emotional preparedness for their relative's death may facilitate more favorable end-of-life-caregiving outcomes and may limit potentially nonbeneficial end-of-life care.

Original languageEnglish
Pages (from-to)199-209
Number of pages11
JournalJournal of Pain and Symptom Management
Issue number2
StatePublished - 02 2022

Bibliographical note

Publisher Copyright:
© 2021 American Academy of Hospice and Palliative Medicine


  • Preparedness for death
  • cancer
  • caregiving outcomes
  • emotional death preparedness
  • end-of-life care
  • neoplasms
  • prognostic awareness


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