Background: Previous studies have shown that prognostic awareness may be harmful to mental
health yet beneficial for end of life care planning. The effects of prognostic awareness coupled
with a sense of inner peace are unknown.
Methods: In the multisite, longitudinal Coping with Cancer Study, 280 patients with advanced
cancer were interviewed at baseline. Patients defining themselves as "terminally ill"
and/or "at peace" most days were paired with others on sociodemographic, mental health and
advance care planning. Primary caregivers of deceased patients were interviewed 6 months
postloss and compared on their physical and mental health and their perceptions of patients'
end-of-life care and death.
Results: Overall, 17.5% of patients reported being both peaceful and aware. Peacefully aware
patients had lower rates of psychological distress and higher rates of advance care planning
(e.g., completing do-not-resuscitate [DNR] orders, advance care planning discussions with
physicians) than those who were not peacefully aware. Additionally, peacefully aware patients
had the highest overall quality of death as reported by their caretakers in a postmortem evaluation.
Surviving caregivers of peacefully aware patients were more physically and mentally
healthy 6 months postloss than caregivers of patients who were "aware" but not peaceful.
Conclusions: Patients with advanced cancer who are peacefully aware have better mental
health and quality of death outcomes, and their surviving caregivers have better bereavement
outcomes. Peaceful awareness is associated with modifiable aspects of medical care (e.g., discussions
about terminal treatment preferences).
