• Kirsten Wentlandt, Debika Burman, Nadia Swami, Sarah Hales, Anne Rydall, Gary Rodin, Christopher Lo, and Camilla Zimmermann.
• Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Canada.
• Psychooncology. 2012 Aug 1; 21 (8): 868-76.

ObjectivePrevious studies regarding patients' end of life (EOL) preparation have focused mainly on practical tasks, such as advance directives. In this study, we investigate the relational and personal aspects of EOL preparation, using a patient-completed questionnaire, and examine associations with clinician-patient communication (CPC) and other variables.MethodsPatients with advanced cancer but with good performance status were recruited from 24 medical oncology clinics, to participate in a cluster-randomised controlled trial of early palliative care intervention. Measures included the Quality of Life at the End of Life preparation for EOL subscale, and measures of CPC, functional status, comorbidity, spiritual well-being and symptom severity. Using chi-squared tests, t-tests and multivariate regression analyses, we examined the variables associated with preparation for EOL. We also examined the frequency distributions of individual EOL preparation items and used logistic regression to examine their associations with adequacy of CPC.ResultsIn the 469 patients, characteristics associated with better EOL preparation were better CPC, older age, living alone, less symptom burden and better spiritual well-being. Thirty-one per cent agreed that they worried 'quite a bit' or 'completely' about their family's preparation to cope with the future, and 27% agreed that they would be a burden to their family. All preparation items except regrets about life were associated with adequacy of communication.ConclusionsA substantial minority of patients with advanced cancer but with good performance status are concerned about EOL preparation, particularly in relation to their families. Better CPC may help patients prepare not only practically but also personally and socially in relation to the dying process and the welfare of their families.Copyright © 2011 John Wiley & Sons, Ltd.

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