The Relationship among Attitudes toward the Withdrawal of Life-sustaining Treatment, Death Anxiety, and Death Acceptance among Hospitalized Elderly Cancer Patients

YeonMi Seo; Sujin Shin

doi:10.5388/aon.2019.19.3.142

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Seo and Shin: The Relationship among Attitudes toward the Withdrawal of Life-sustaining Treatment, Death Anxiety, and Death Acceptance among Hospitalized Elderly Cancer Patients

Original Article

Asian Oncol Nurs 2019;19(3):142-149.

Published online: 12 September 2019

DOI: https://doi.org/10.5388/aon.2019.19.3.142

The Relationship among Attitudes toward the Withdrawal of Life-sustaining Treatment, Death Anxiety, and Death Acceptance among Hospitalized Elderly Cancer Patients

YeonMi Seo¹, Sujin Shin²

^¹Department of Nursing, Asan Medical Center, Seoul

^²College of Nursing, Ewha Womans University, Seoul, Korea

Address reprint requests to: Shin, Sujin College of Nursing, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea Tel: +82-2-3277-2726 Fax: +82-2-3277-2850 E-mail: ssj1119@ewha.ac.kr

* This article is a revision of the first author's master's thesis from Ewha Womans University.

Revised 2 July 2019 Revised 14 August 2019 Accepted 9 September 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to identify the relationship between attitudes toward the withdrawal of life-sustaining treatment, death anxiety and death acceptance among hospitalized cancer patients who were at least 65 years old.

Methods

This study adopted a descriptive study design. Data were collected from 128 patients diagnosed with cancer. The instruments used were the Attitudes toward Life-sustaining Treatment Scale, Death Anxiety Scale and modified versions of the Death Attitude Profile-Revised (DAP-R) questionnaire.

Results

The mean score for the subjects’ attitudes toward the withdrawal of life-sustaining treatment was 3.48 ±0.50 out of 5. Death anxiety was reported at 2.53±0.54 out of 4. Death acceptance was reported at 4.10 ±1.20 out of 7. There was a significant negative correlation between the subjects’ attitudes toward the withdrawal of life-sustaining treatment and death anxiety (r= −.21, p=.018), however there was no statistically significant correlation between the subjects’ attitude towards the withdrawal of life-sustaining treatment and death acceptance (r=-.07, p=.462).

Conclusion

The more positive elderly cancer patients are about the withdrawal of life-sustaining treatment, the lower their death anxiety is. This finding can help nurses with patient care towards the end of life by considering the relationship between death anxiety and their attitudes toward the withdrawal of life-sustaining treatment.

Keywords: Aged, Cancer, Advanced care planning, Attitude to death, Anxiety

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Table 1.

Difference in Attitudes toward the Withdrawal of Life-sustaining Treatment, Death Anxiety and Death Acceptance according to General and Clinical Characteristics (N= 128)

Variables	Categories	n (%)	Attitudes toward the withdrawal of life-sustaining treatment		Death anxiety		Death acceptance
Variables	Categories	n (%)	M ± SD	t or F (p)	M ± SD	t or F (p)	M ± SD	t or F (p)
Gender	M	77 (60.2)	3.46 ± 0.53	–0.35	2.49 ± 0.52	–0.95	4.04 ± 1.24	–0.63
Gender	F	51 (39.8)	3.50 ± 0.45	(.727)	2.58 ± 0.57	(.344)	4.18 ± 1.16	(.532)
Age (year)	65∼74	84 (65.6)	3.48 ± 0.55	–0.04	2.52 ± 0.55	–0.21	4.12 ± 1.20	0.29
Age (year)	≥ 75	44 (34.4)	3.48 _± 0.40	(.970)	2.54 _± 0.53	(.831)	4.05 _± 1.22	(.770)
Educational status	≤ Primary	30 (23.4)	3.46 ± 0.53	1.66^†	2.64 ± 0.51	3.46^†	4.13 ± 1.09	1.53^†
	Intermediate High School	33 (25.8)41 (32.0)	3.46 ± 0.423.45 0.47	(.645)^†	2.61 ± 0.532.41 0.51	(.326)^†	4.24 ± 1.134.09 1.28	(.677)^†
	High School	41 (32.0)	3.45 ± 0.47		2.41 ± 0.51		4.09 ± 1.28
	≥ University	24 (18.8)	3.56 ± 0.61		2.46 ± 0.62		3.87 ± 1.34
Religion	Yes	83 (64.8)	3.48 ± 0.47	–0.04	2.52 ± 0.59	0.25	4.30 ± 1.23	–2.61
Religion	No	45 (35.2)	3.47 ± 0.55	(.970)	2.54 ± 0.45	(.805)	3.73 ± 1.08	(.010)
Relationship with caregiver^*	Spouse Children	87 (68.0)	3.52 ± 0.44	N/A	2.51 ± 0.54	N/A	4.18 ± 1.18	N/A
	Children	63 (49.2)	3.40 _± 0.54		2.58 _± 0.07		4.06 _± 0.14
	Brothers, sisters or the others	6 (4.7)	3.22 ± 0.59		2.63 ± 0.23		3.97 ± 1.59
Period since cancer diagnosis (year)	＜1 ^a 1∼2.9^b	46 (35.9)45 (35.2)	3.49 ± 0.423.53 0.57	3.57 (.311)^†	2.39 ± 0.442.50 0.56	4.65 (.004)	3.95 ± 1.163.99 1.35	1.88 (.137)
	1∼2.9 ^b ^c	45 (35.2)	3.53 ± 0.57	(.311)^†	2.50 ± 0.56	(.004)	3.99 ± 1.35	(.137)
	3∼4.9 ^c	17 (13.3)	3.30 _± 0.55		2.93 _± 0.62	a, b＜ c	4.71 _± 0.94
	≥ 5 ^d	20 (15.6)	3.47 ± 0.45		2.57 ± 0.52		4.15 ± 1.06
Perceived burdensome of medical expense	No ^a	30 (23.4)	3.30 ± 0.58	3.83	2.40 ± 0.78	0.60	4.21 ± 1.05	2.37
	Average^b	44 (34.4)	3.44 ± 0.50	(.024)	2.56 ± 0.46	(.549)^‡	4.34 ± 1.20	(.098)
	Yes ^c	54 (42.2)	3.60 ± 0.41	c＞ a	2.57 ± 0.43		3.84 ± 1.25

^* Multiple response;

^† Kruskal-Wallis test;

^‡ Welch test.

Table 2.

Difference in Attitudes toward the Withdrawal of Life-sustaining Treatment, Death Anxiety and Death Acceptance according to Advanced Care Planning related Characteristics (N= 128)

Variables	Categories	n (%)	Attitudes toward the withdrawal of life-sus-taining treatment		Death anxiety		Death acceptance
Variables	Categories	n (%)	M ± SD	t (p)	M ± SD	t (p)	M ± SD	t (p)
Prepared advance directives	Yes	23 (18.0)	3.62 ± 0.41	1.54	2.41 ± 0.49	–	4.68 ± 1.30	2.61
Prepared advance directives	No	105 (82.0)	3.44 ± 0.51	(.127)	3.44 ± 0.51	(.506)^*	2.55 ± 0.55	(.010)
Education about advanced care plan	Yes	36 (28.1)	3.53 ± 0.47	0.73	2.54 ± 0.53	0.20	4.62 ± 1.28	3.22
Education about advanced care plan	No	92 (71.9)	3.46 ± 0.51	(.465)	2.52 ± 0.55	(.842)	3.89 ± 1.11	(.002)
Discussion advanced care plan with others	Yes	48 (37.5)	3.68 _± 0.48	1.77	2.54 _± 0.56	0.19	4.31 _± 1.34	1.51
Discussion advanced care plan with others	No	80 (62.5)	3.42 ± 0.50	(.079)	2.52 ± 0.53	(.850)	3.97 ± 1.10	(.134)
In case acquaintances has been received life-sustaining treatment before	Yes	17 (13.3)	3.57 _± 0.43	–	2.43 _± 0.42	–0.78	3.76 _± 1.51	–1.23
	No	111 (86.7)	3.46 ± 0.51	(.243)^*	2.54 ± 0.56	(.435)	4.15 ± 1.15	(.222)
In case acquaintances has been withdrawn life-sustaining treatment before	Yes	12 (9.4)	3.66 ± 0.49	–	2.42 ± 0.37	–0.74	4.23 ± 1.50	0.41
	No	116 (90.6)	3.46 ± 0.50	(.062)^*	2.54 ± 0.56	(.464)	4.08 ± 1.18	(.686)

^* Mann Whitney test.

Table 3.

Level of Attitudes toward the Withdrawal of Life-sustaining Treatment, Death Anxiety and Death Acceptance (N= 128)

Variables	Categories	M ± SD	Actual range	Possible range
Attitudes toward the withdrawal of life-sustaining treatment		3.48 ± 0.50	1.74∼4.58	1∼5
Death anxiety	Total	2.53 _± 0.54	1∼4	1∼4
	Result after death	2.54 ± 0.77	1∼4	1∼4
	Death process	2.95 ± 0.66	1∼4	1∼4
	Loss of existence	2.17 ± 0.72	1∼4	1∼4
Death acceptance	Total	4.10 ± 1.20	1.79∼6.71	1∼7
	Approach acceptance	3.72 ± 1.56	1.00∼6.75	1∼7
	Escape acceptance	3.72 ± 1.51	1∼7	1∼7
	Neutral acceptance	5.47 ± 1.20	1.33∼7.00	1∼7

Table 4.

Correlations among Attitudes toward the Withdrawal of Life-sustaining Treatment, Death Anxiety and Death Acceptance of the Subjects (N= 128)

Variables	Attitudes toward the withdrawal of life-sustaining treatment	Death anxiety	Death acceptance
Variables	r (p)	r (p)	r (p)
Attitudes toward the withdrawal of life-sustaining treatment	1
Death anxiety	–.21 (.018)	1
Death acceptance	–.07 (.462)	.12 (.184)	1

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