Factors Associated with Patient–Caregiver Concordance about Life-Sustaining Treatment Preferences among Advanced Cancer Patients: A Cross-Sectional Study

Objectives: Concordance of preferences for end-of-life care regarding patients between patients with advanced cancer and family caregivers can improve the likelihood of honoring dying patients’ wishes. However, there is a dearth of knowledge in mainland China. The purpose of this study was to examine patient–family caregiver concordance about patients’ life-sustaining treatment preferences and associated factors among patients with advanced cancer in China. Methods: From September 2019 to December 2021, a convenience sample of 406 dyads of advanced cancer patient–family caregiver were recruited from 2 tertiary hospitals in Wuhan, China. Participants completed a questionnaire about patient's preferences for life-sustaining treatment, respectively. The concordance was assessed by percent agreement and kappa coefficients. Associated factors were identified by univariate analysis and binary logistic regression. Results: The average concordance rate on the preferences for life-sustaining treatment was 56.1%, ranging from 52.9% to 59.3%. Factors associated with a higher level of patient–family caregiver concordance were following: patients who were married, whose educational levels were at college or above, who had not been informed of diagnosis by a physician, who had been informed of the effects and side effects of related drugs by a physician, and who cared for a seriously ill family member or friend and caregivers whose educational level were primary or below. Conclusions: The patient–family caregiver concordance about patients’ life-sustaining treatment preferences among patients with advanced cancer was poor. Patients’ and caregivers’ understanding of life-sustaining treatment and its efficacy in end-of-life should be facilitated. Relevant conversation should be encouraged between patients and caregivers, thus providing value-concordant end-of-life care for patients with cancer. Implications for Nursing Practice: Health professionals need to carry out advanced care planning in oncology departments on mainland China to encourage patients and caregivers to discuss patients’ end-of-life care preferences. Facilitating patients’ and caregivers’ understanding of life-sustaining treatment preferences may help improve the patient–caregiver concordance on life-sustaining treatment preferences among patients with advanced cancer.