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Despite dyadic interdependence of preparedness for death, associations of death preparedness (conjoint cognitive prognostic awareness and emotional acceptance) with psychological distress and quality of life (QOL) have been mainly examined cross-sectionally in patients or caregivers. This study longitudinally assessed associations of patient-caregiver concordance on death preparedness with dyads' psychological distress, QOL, and caregivers’ burden. Among 520 Taiwanese terminal cancer dyads, multivariate hierarchical linear models examined associations between death-preparedness concordance and anxiety, depression, QOL, and caregiving burden, separately for patients and caregivers across four concordant states (unprepared-concordant, cognitive-concordant, emotional-concordant, and sufficient-concordant) versus discordance, reported as β estimates with 95 % confidence intervals. Death-preparedness concordance was associated with outcomes, except unprepared concordance showed no association with patient outcomes, and emotional concordance was unrelated to caregiver outcomes. Relative to the discordant group, patients in the cognitive-concordant state had more anxiety (0.927 0.364, 1.490) and worse QOL (−3.933 -6.661, −1.205), whereas those in the emotional-concordant state had fewer symptoms of anxiety (−1.913 -3.154, −0.672) and depression (−1.617 -3.128, −0.106). The sufficient-concordant state was associated with fewer anxiety symptoms (−0.940 -1.471, −0.409) and better QOL (4.119 1.252, 6.986). Caregivers in unprepared- and cognitive-concordant states had more depressive symptoms and worse QOL, while those in the sufficient-concordant state reported fewer depressive symptoms (−1.960 -3.348, −0.572) and better QOL (3.922 1.419, 6.425). Cognitive-concordant caregivers also reported higher subjective burden (2.228 0.962, 3.494). Sufficient concordance in death preparedness reduces patient anxiety and caregiver depression while improving dyads’ QOL, underscoring its role in enhancing end-of-life outcomes. • Death preparedness is dyadically interdependent in cancer patient–caregiver pairs. • Sufficient death preparedness implies accurate prognostic awareness and emotional readiness. • Sufficient concordance reduces anxiety symptoms in terminally ill cancer patients. • Sufficient concordance reduces depressive symptoms in family caregivers. • Sufficient concordance improves quality of life for both patients and caregivers.
Wen et al. (Wed,) studied this question.