Does the awareness of terminal illness influence cancer patients' psycho-spiritual state, and their DNR signing: A survey in Taiwan

Objective: The aim of the study was to explore the relationships between truth telling, patients' psycho-spiritual state and do not resuscitate consent. Methods: Cancer patients who had consulted with hospice care at the National Taiwan University Hospital in Taipei were approached. Patients excluded from the study included those who were unable to give informed consent, not well enough to complete the questionnaire survey, would be discharged within 24 h or who could not communicate in Chinese or Taiwanese. The 90 patients recruited for the study were grouped according to their awareness of their terminal prognosis ('aware' or 'unaware'). A structured questionnaire was used for data collection, including questions on uncertainty, the Hospital Anxiety and Depression Scale and the Spiritual Well-being Scale. Results: Truth telling reduced cancer patients' uncertainty (P = 0.023) and anxiety (P = 0.005), and did not affect their state of spiritual well-being (P = 0.868). Before hospice referral, patients aware of their prognosis were more likely to sign the do not resuscitate consent (P = 0.040). In the aware group, 28% signed the do not resuscitate themselves, whereas in the unaware group, only 5% signed the do not resuscitate themselves (P = 0.031). The median time between signing the do not resuscitate and death was 29 days in the aware group and 16 days in the unaware group. Data revealed that 82% of the aware group died having given their do not resuscitate consent and did not receive a vasopressor or intubation, whereas only 52% of the unaware group died in this manner. Conclusions: Truth telling can reduce cancer patients' uncertainty and anxiety. Patients aware of their prognosis tended to sign the do not resuscitate consent willingly and had more dignified and peaceful deaths.