Good Death and Quality of End-of-Life Care in Patients with Coexisting Cancer and Dementia: Perspective of Bereaved Families

Abstract

Background: Patients with coexisting cancer and dementia often have complex health care needs and face challenges in achieving a good death. Objectives: To evaluate good death achievement and end-of-life (EOL) care in patients with coexisting cancer and dementia from the perspective of bereaved families. Design: Cross-sectional nationwide postal survey. Setting/Subjects: Bereaved families of patients with cancer who died in hospice and palliative care units across Japan. Measurements: Bereaved families completed an anonymous, self-reported questionnaire. Their perspective on achieving a good death was assessed using the Good Death Inventory (GDI) (total score: 18–126). The Revised Care Evaluation Scale—short version (CES2) was used to assess EOL care (total score: 10–60). We examined the Brief Grief Questionnaire (BGQ) (total score: 0–10) and Patient Health Questionnaire 9 (PHQ9) (total score: 0–27). Results: Data from 670 participants were analyzed, including 83 (12.4%) bereaved families of patients with coexisting cancer and dementia. No statistical differences were observed in the total GDI score for 18 items (dementia comorbidity vs. nondementia comorbidity groups, mean – standard deviation, respectively, 78.4 – 17.7 vs. 80.0 – 15.5, adjusted [adj] P = 0.186), CES2 score (49.70 – 9.22 vs. 48.82 – 8.40, adj P = 0.316), BGQ score (3.40 – 2.41 vs. 4.36 – 2.28, adj P = 0.060), and PHQ9 score (4.67 – 4.71 vs. 5.50 – 5.37, adj P = 0.788). Conclusions: GDI, CES2, BGQ, and PHQ9 scores did not differ significantly between groups, regardless of the presence of dementia in hospice and palliative care units. Patients with coexisting cancer and dementia can achieve a good death by high-quality EOL care.