Attitudes toward end-of-life concerns and associated factors among hospitalized older adults with end-stage cancer in Iran

Abstract

Background: Nurses play a crucial role in delivering end-of-life care; however, patients' attitudes significantly influence the care process. Positive attitudes facilitate patient engagement and understanding of end-of-life options, while negative attitudes can induce fear and distress. Addressing patient concerns and associated factors is essential for enhancing care during the end-stage period.Objectives: This study aimed to evaluate attitudes toward end-of-life concerns and associated factors among hospitalized older adults with end-stage cancer.Methods: This cross-sectional study was conducted from November 2022 to March 2023 at Omid Hospital in Isfahan, Iran. A sample of 150 participants was selected through consecutive sampling. Data were collected using questionnaires on demographic characteristics, attitudes toward end-of-life issues, and the Mini-Mental State Examination. Statistical analyses were performed using SPSS version 22, including independent t-tests, chi-square tests, Fisher's exact test, and binomial logistic regression.Results: The mean age of participants was 71.95 ± 6.04 years. The mean score for end-of-life concerns was 67.11 out of 135. A majority of participants preferred physician-led decision-making (76.7%) and did not support euthanasia as a personal choice (72%). Furthermore, most participants disagreed with the notion of dying alone (78.7%) and expressed a preference for home care (78.7%). Logistic regression identified three significant factors associated with end-of-life concerns: time since diagnosis (OR = 27.914, CI: 1.144–680.922, P < 0.001), marital status (OR = 0.847, CI: 0.811–0.884, P = 0.041), and family caregiver status (OR = 2.603, CI: 0.419–0.866, P = 0.006).Conclusion: Healthcare professionals should recognize and address end-of-life concerns by offering personalized support to older adults. Nurses should focus on supporting decision-making, pain management, preferred care settings, and the regulation of living wills.