Patient characteristics are available in . Deceased patients (N=90) who had post-mortem assessments available survived a median of 84 days (SD 94 days) from enrollment. Median follow-up on the remaining patients, who were either alive, or dead but without post-mortem assessments available, was 248 days from enrollment (SD 153 days). THC scores had no relationship with gender, race, marital status, income or education. Older patients tended to have lower THC scores (decrease in score by 0.23 per increasing year of age, P=.001) than younger patients.
THC scores were inversely associated with a SCID diagnosis of post-traumatic stress disorder (P=.0001, ). Although THC scores were not significantly associated with a current diagnosis of major depression (P=.53) or generalized anxiety disorder (P=.12), scores were inversely associated with the presence of any current major psychiatric disorder (P=.03).
Association between therapeutic alliance and DSM diagnosis of psychiatric illness.
THC scores were also associated with some self-reported psychological states on the McGill QOL scale. For example, THC scores were inversely associated with feeling depressed (r=−.23, P=.0006) and terrified about the future (r=−.17, P=.01), and with the summary score for psychological symptoms (r=−.18, P=.007). In contrast, THC scores were positively associated with patients’ reports of support (r=.28, P<.0001) and existential well-being (r=.16, P=.02).
Spirituality was not significantly associated with THC score (P=.06). Some coping strategies were associated with THC scores, however. Patients who used emotion-based coping techniques tended to have higher THC scores, for example (r=.28, P<.0001), while avoidant coping was inversely associated with THC score (r=−.15, P=.02). THC scores were not associated with active coping techniques (r=.07, P=.28).
THC scores were not associated with comorbid conditions (r=−.09, P=.21) but were associated with functional status (Karnofsky score, r=.22, P=.001; Zubrod score, r=−.20, P=.003), with greater scores among those patients with better functional status. Similarly, patients with a higher burden of symptoms (McGill symptom burden, r=−.19, P=.006) tended to have lower THC scores. THC scores were not significantly related to proximity to death, however (r=.17, P=.10), among patients who died.
THC scores for patients who reported having discussions with their physicians about EOL care preferences (mean 54.97, SD 7.13) were no different from the scores of patients who did not report such discussions (mean 54.54, SD 7.66, P=.68, ). Scores were also similar whether the patient did (55.11, SD 7.68) or did not (54.32, SD 7.19, P=.49) acknowledge having a terminal illness. Although THC was not associated with cognitive acceptance, it was associated with emotional acceptance of a terminal illness (PEACE score for Peaceful Acceptance, r=.31, P<.0001).
Association between THC and cognitive EOL awareness and planning.
THC scores were not related to the presence of a do-not-resuscitate order at the time of questionnaire completion (P=.37), but patients with other forms of advance care planning such as living wills, health care proxies, or durable powers of attorney tended to have lower THC scores (53.97, SD 8.07) than patients who had not completed these types of advance care planning (57.05, SD 4.85, P=.002).
Among the 90 patients who had died, patients who received care in the intensive care unit in the last week of life had lower THC scores (mean 46.5, SD 8.26) than patients who did not receive ICU-based care in the last week (55.5, SD 6.33, P=.002, ). Death in the hospital was also marginally, though not statistically significantly, associated with THC score (P=.06), with lower THC scores among patients who died in the hospital (50.36, SD 9.25) than among patients who died in other locations (55.68, SD 5.96). Caregiver-rated quality of patient death, however, was not associated with THC score (r=.17, P=.11).
Association between THC and end-of-life care experiences