Breast (Edinburgh, Scotland) · 2026
End-of-life care values and treatment preferences among Japanese breast cancer patients and families: A dyadic cross-sectional study.
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Hara Akemi, Ajitomi Ayu, Tachibana Kazunoshin, Gonda Kenji, Wada Masahiro, Omori Rui, Arai Megumi, Konuma Kayoko, Sawano Toyoaki, Kanemoto Yoshiaki, Miyatake Hirotomo, Kurokawa Tomohiro, Kouchi Yukiko, Kanzaki Norio, Kotera Yasuhiro, Takebayashi Yoshitake, Murakami Michio, Ohtake Tohru, Shimmura Hiroaki, Ozaki Akihiko
Аннотация
BACKGROUND: Patient-family discordance in end-of-life values complicates advance care planning (ACP) but is rarely quantified in Asian oncology settings. We measured patient-family differences in values and treatment preferences in breast cancer and correlates of discordance.
METHODS: In this single-center cross-sectional study at a Japanese breast-cancer unit (August 2024-May 2025), 470 patients completed a questionnaire on Life Priorities and Values (14 items) and End-of-Life Care Preferences (6 items); 218 were matched to 324 family respondents. Analyses used generalized linear mixed-effects models, Cohen's κ, multiple correspondence analysis (MCA), an actor-partner interdependence model (APIM) on MCA dimension scores, and a total discordance score.
RESULTS: Patients prioritized autonomy ("Independence in ADL," OR = 0.20; "Not being a burden to family," OR = 0.31), families intervention ("Longevity," OR = 2.15; "Treatment until satisfaction," OR = 4.50; all p < .001). Concordance was uniformly poor (κ 0.03-0.32) and directional: 88.5% of disagreements on treatment pursuit were on the family-endorsement side. Prior ACP discussion was associated with lower discordance (median 6 vs 7, p < .001), chiefly for palliative items, and chemotherapy with higher discordance (p = .012). Exploratory APIM showed strong actor associations and two partner associations for family Preference Dim2: patients' greater value engagement and longevity orientation were each associated with higher family endorsement of active treatment (p = .022 and 0.002).
CONCLUSIONS: Systematic, directional patient-family discordance was present across nearly all end-of-life domains. Prior ACP discussion was associated with lower discordance, particularly for palliative preferences, supporting structured dyadic communication in breast cancer care.
METHODS: In this single-center cross-sectional study at a Japanese breast-cancer unit (August 2024-May 2025), 470 patients completed a questionnaire on Life Priorities and Values (14 items) and End-of-Life Care Preferences (6 items); 218 were matched to 324 family respondents. Analyses used generalized linear mixed-effects models, Cohen's κ, multiple correspondence analysis (MCA), an actor-partner interdependence model (APIM) on MCA dimension scores, and a total discordance score.
RESULTS: Patients prioritized autonomy ("Independence in ADL," OR = 0.20; "Not being a burden to family," OR = 0.31), families intervention ("Longevity," OR = 2.15; "Treatment until satisfaction," OR = 4.50; all p < .001). Concordance was uniformly poor (κ 0.03-0.32) and directional: 88.5% of disagreements on treatment pursuit were on the family-endorsement side. Prior ACP discussion was associated with lower discordance (median 6 vs 7, p < .001), chiefly for palliative items, and chemotherapy with higher discordance (p = .012). Exploratory APIM showed strong actor associations and two partner associations for family Preference Dim2: patients' greater value engagement and longevity orientation were each associated with higher family endorsement of active treatment (p = .022 and 0.002).
CONCLUSIONS: Systematic, directional patient-family discordance was present across nearly all end-of-life domains. Prior ACP discussion was associated with lower discordance, particularly for palliative preferences, supporting structured dyadic communication in breast cancer care.