Prognostic Disclosure, End-of-Life Communication, and Social Support Associated With Distinct Dyadic Death-Preparedness States Among Cancer Dyads.

BACKGROUND: Preparing for death is relational because patients with advanced cancer and family caregivers confront approaching death together. We examined individual and relational factors associated with distinct dyadic death-preparedness states during patients' final six months of life. PATIENTS AND METHODS: In this longitudinal cohort study of 694 patient-caregiver dyads, hierarchical generalized linear models with lagged time-varying predictors examined unprepared-concordant, cognitive-concordant, emotional-concordant, and sufficient-concordant states versus discordance across individual, relationship, and relationship-process domains. RESULTS: Older patient age was associated with lower likelihood of cognitive concordance but higher likelihood of sufficient concordance, and higher patient educational attainment was associated with sufficient concordance. Patient- and caregiver-reported physician prognostic disclosure was associated with higher likelihoods of cognitive concordance (AORs, 3.416 and 2.411, respectively) and sufficient concordance (AORs, 3.743 and 2.854, respectively). Greater patient-reported end-of-life discussions with caregivers were associated with a higher likelihood of cognitive concordance (AOR, 1.190; 95% CI, 1.106-1.279) but a lower likelihood of emotional concordance (AOR, 0.800; 95% CI, 0.650-0.985). Higher patient- and caregiver-reported social support was associated with a lower likelihood of cognitive concordance (AORs, 0.956 and 0.945, respectively). CONCLUSION: Relationship-process factors were more consistently associated with dyadic death-preparedness states than individual or relationship characteristics. These findings support assessing both patients' and caregivers' cognitive and emotional preparedness and considering reported prognostic disclosure, patient-caregiver end-of-life discussions, and social-support dynamics when evaluating dyadic preparation for death.