Gap in the Intensity of End-of-Life Care between Younger and Older Taiwanese Adult Cancer Patients may not Reflect Younger Patients’ Preferences

Abstract

BackgroundStudies on age-related differences in preferences for end-of-life (EOL) care have generally concluded that increasing age predisposes patients to prefer less aggressive EOL care. However, these studies seldom are adjusted for healthcare needs, health behaviors, and healthcare system characteristics. PurposeTo evaluate the impact of age on terminally ill cancer patients’ preferences for EOL care while adjusting for healthcare needs, health behaviors and the characteristics of the healthcare system. MethodsWe obtained our research data for this study from a cross-sectional survey of 2329 terminally ill cancer patients sampled by convenience from 23 hospitals throughout Taiwan. ResultsThe preferences of Taiwanese terminally ill cancer patients did not differ significantly by age in their choices regarding comfort-oriented treatments as their goal for EOL care, receiving cardiac pulmonary resuscitation (CPR) when their life was in danger, or undergoing aggressive life-sustaining treatments at EOL (including cardiac massage, intubation, and mechanical ventilation support). However, terminally ill cancer patients ≤ 44 years of age were significantly more likely than those ≥75 years of age to prefer prolonging life as their goal of EOL care and receiving intensive care unit (ICU) care. Furthermore, patients 45-64 years of age were 1.44 (95% CI: 1.06, 1.95) more and 0.60 (0.47, 0.77) times less likely than those ≥75 years of age to prefer hospice care and dying at home, respectively. ConclusionsExcept for EOL-care goals, ICU care, hospice care, and place of death, preferences for specific aggressive life-sustaining treatments did not differ by age group of Taiwanese terminally ill cancer patients. We speculate that the age-related gap in intensity of EOL care among Taiwanese cancer decedents (younger cancer decedents received more life-sustaining treatments, i.e., ICU care, CPR, and intubation with mechanical ventilation support in the last month of life) may not reflect the preferences of younger patients.