Determinants of Patient-Family Caregiver Congruence on Preferred Place of Death in Taiwan

Context. Patient-family caregiver congruence on preferred place of death not only increases the likelihood of dying at home but also contributes significantly to terminally ill cancer patients' quality of life. Objectives. To examine the determinants of patient-family caregiver congruence on the preferred place of death in Taiwan. Methods. Patient-family caregiver dyads (n = 1,108) were surveyed on preferences and needs for end-of-life (EOL) care. Determinants of congruence on preferences were identified by multivariate logistic regression. Results. Patient-caregiver dyads achieved 78.1% agreement on the preferred place of death. The kappa coefficient of congruence was 0.55 (95% confidence interval [CI] = 0.50, 0.60). The extent of patient-family caregiver congruence on preferred place of death increased with the patient's higher functional dependence (adjusted odds ratio [AOR] and 95% CI = 1.04 [1.02, 1.05]), higher patient-rated importance for dying at preferred place of death (AOR [95% CI] = 1.60 [1.43, 1.79]), and having a spousal caregiver (AOR [95% CI] = 1.62 [1.14, 2.31]). Other determinants of patient-family caregiver congruence included patient age (AOR [95% CI] = 1.01 [1.00, 1.03]), patient-family concordance on preferred EOL care options (AOR = 1.68-1.73), patient knowledge of prognosis (AOR [95% CI] = 0.68 [0.48, 0.97]), and impact of caregiving on the family caregiver's life (AOR [95% Cl] = 0.98 [0.96, 0.99]). Conclusion. Increasing patient-family congruence on preferred place of death not only requires knowledge of the patient's prognosis and advance planning by both parties but also depends on family caregivers endorsing patient preferences for EOL care options and ensuring that supporting patients dying at home does not create an intolerable burden for family caregivers. J Pain Symptom Manage 2010;40:235-245. (C) 2010 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.