{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T02:51:59Z","timestamp":1791427919722,"version":"4.3.3"},"reference-count":47,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T00:00:00Z","timestamp":1790380800000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007225","name":"Ministry of Science and Technology","doi-asserted-by":"publisher","award":["MOST 104-2314-B-182-027-MY3"],"award-info":[{"award-number":["MOST 104-2314-B-182-027-MY3"]}],"id":[{"id":"10.13039\/100007225","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007225","name":"Ministry of Science and Technology","doi-asserted-by":"publisher","award":["MOST 105-2314-B-182-040-MY3"],"award-info":[{"award-number":["MOST 105-2314-B-182-040-MY3"]}],"id":[{"id":"10.13039\/100007225","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Preparing for death is relational because patients with advanced cancer and family caregivers confront approaching death together. We examined individual and relational factors associated with distinct dyadic death-preparedness states during patients\u2019 final 6 months of life.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>In this longitudinal cohort study of 694 patient-caregiver dyads, hierarchical generalized linear models with lagged time-varying predictors examined unprepared-concordant, cognitive-concordant, emotional-concordant, and sufficient-concordant states versus discordance across individual, relationship, and relationship-process domains.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Older patient age was associated with lower likelihood of cognitive concordance but higher likelihood of sufficient concordance, and higher patient educational attainment was associated with sufficient concordance. Patient- and caregiver-reported physician prognostic disclosure was associated with higher likelihoods of cognitive concordance (AORs, 3.416 and 2.411, respectively) and sufficient concordance (AORs, 3.743 and 2.854, respectively). Greater patient-reported end-of-life discussions with caregivers were associated with a higher likelihood of cognitive concordance (AOR, 1.190; 95% CI, 1.106-1.279) but a lower likelihood of emotional concordance (AOR, 0.800; 95% CI, 0.650-0.985). Higher patient- and caregiver-reported social support was associated with a lower likelihood of cognitive concordance (AORs, 0.956 and 0.945, respectively).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Relationship-process factors were more consistently associated with dyadic death-preparedness states than individual or relationship characteristics. These findings support assessing both patients\u2019 and caregivers\u2019 cognitive and emotional preparedness and considering reported prognostic disclosure, patient-caregiver end-of-life discussions, and social-support dynamics when evaluating dyadic preparation for death.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/oncolo\/oyag381","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T11:15:03Z","timestamp":1790334903000},"source":"Crossref","is-referenced-by-count":0,"title":["Prognostic disclosure, end-of-life communication, and social support associated with distinct dyadic death-preparedness states among cancer dyads"],"prefix":"10.1093","volume":"31","author":[{"given":"Fur-Hsing","family":"Wen","sequence":"first","affiliation":[{"name":"Department of International Business, Soochow University , Taipei, Taiwan, 100006, ROC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5547-409X","authenticated-orcid":false,"given":"Chia-Hsun","family":"Hsieh","sequence":"additional","affiliation":[{"name":"College of Medicine, Chang Gung University , Tao-Yuan, Taiwan, 333323, ROC"},{"name":"Division of Hematology-Oncology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, 333423, ROC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0361-4548","authenticated-orcid":false,"given":"Wen-Chi","family":"Chou","sequence":"additional","affiliation":[{"name":"College of Medicine, Chang Gung University , Tao-Yuan, Taiwan, 333323, ROC"},{"name":"Division of Hematology-Oncology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, 333423, ROC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9756-3974","authenticated-orcid":false,"given":"Jen-Shi","family":"Chen","sequence":"additional","affiliation":[{"name":"College of Medicine, Chang Gung University , Tao-Yuan, Taiwan, 333323, ROC"},{"name":"Division of Hematology-Oncology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, 333423, ROC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8373-5691","authenticated-orcid":false,"given":"Wen-Cheng","family":"Chang","sequence":"additional","affiliation":[{"name":"College of Medicine, Chang Gung University , Tao-Yuan, Taiwan, 333323, ROC"},{"name":"Division of Hematology-Oncology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, 333423, ROC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8509-2087","authenticated-orcid":false,"given":"Siew Tzuh","family":"Tang","sequence":"additional","affiliation":[{"name":"School of Nursing, Medical College, Chang Gung University , Tao-Yuan, Taiwan, 333323, ROC"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,25]]},"reference":[{"key":"2026100722465797600_oyag381-B1","doi-asserted-by":"crossref","first-page":"114357","DOI":"10.1016\/j.socscimed.2021.114357","article-title":"The dyadic cancer outcomes framework: a general framework of the effects of cancer on patients and informal caregivers","volume":"287","author":"Thompson","year":"2021","journal-title":"Soc Sci Med"},{"key":"2026100722465797600_oyag381-B2","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1002\/pon.5895","article-title":"The shared uncertainty experience of older adults with advanced cancer and their caregivers","volume":"31","author":"Zhang","year":"2022","journal-title":"Psychooncology"},{"key":"2026100722465797600_oyag381-B3","doi-asserted-by":"crossref","first-page":"e70068","DOI":"10.1002\/pon.70068","article-title":"Psychosocial correlates of death anxiety in advanced cancer: a scoping review","volume":"34","author":"Brown","year":"2025","journal-title":"Psychooncology"},{"key":"2026100722465797600_oyag381-B4","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1089\/jpm.2006.0134","article-title":"The dying role","volume":"10","author":"Emanuel","year":"2007","journal-title":"J Palliat Med"},{"key":"2026100722465797600_oyag381-B5","doi-asserted-by":"crossref","first-page":"1164","DOI":"10.1089\/jpm.2006.9.1164","article-title":"Preparing caregivers for the death of a loved one: a theoretical framework and suggestions for future research","volume":"9","author":"Hebert","year":"2006","journal-title":"J Palliat Med"},{"key":"2026100722465797600_oyag381-B6","doi-asserted-by":"crossref","first-page":"378","DOI":"10.2307\/2137315","article-title":"Socialization to dying: social determinants of death acknowledgment and treatment among terminally ill geriatric patients","volume":"33","author":"Prigerson","year":"1992","journal-title":"J Health Soc Behav"},{"key":"2026100722465797600_oyag381-B7","doi-asserted-by":"crossref","first-page":"e6276","DOI":"10.1002\/pon.6276","article-title":"Factors associated with the preparedness for bereavement in families of patients with cancer: a secondary analysis of a nationwide bereaved family survey","volume":"33","author":"Matsuzaka","year":"2024","journal-title":"PsychoOncology"},{"key":"2026100722465797600_oyag381-B8","doi-asserted-by":"crossref","first-page":"oyae353","DOI":"10.1093\/oncolo\/oyae353","article-title":"Patient-caregiver concordance on death preparedness over cancer patients\u2019 last six months","volume":"30","author":"Wen","year":"2025","journal-title":"Oncologist"},{"key":"2026100722465797600_oyag381-B9","doi-asserted-by":"crossref","first-page":"100553","DOI":"10.1016\/j.ssmmh.2025.100553","article-title":"Associations of patient-caregiver concordance on death preparedness with dyads\u2019 end-of-life outcomes","volume":"8","author":"Wen","year":"2025","journal-title":"SSM - Mental Health"},{"key":"2026100722465797600_oyag381-B10","first-page":"459","article-title":"Dyadic-concordance death-preparedness states and end-of-life care received by cancer patients","volume":"34","author":"Wen","year":"2026","journal-title":"Support Care Cancer"},{"key":"2026100722465797600_oyag381-B11","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1016\/S0140-6736(21)02314-X","article-title":"Lancet commission on the value of death. Report of the lancet commission on the value of death: bringing death back into life","volume":"399","author":"Sallnow","year":"2022","journal-title":"Lancet"},{"key":"2026100722465797600_oyag381-B12","doi-asserted-by":"crossref","first-page":"e365","DOI":"10.1016\/j.jpainsymman.2021.11.015","article-title":"Identifying core domains to assess the \u201cquality of death\u201d: a scoping review","volume":"63","author":"Bhadelia","year":"2022","journal-title":"J Pain Symptom Manage"},{"key":"2026100722465797600_oyag381-B13","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1016\/j.soncn.2019.06.004","article-title":"Dyadic interventions for cancer survivors and caregivers: State of the science and new directions","volume":"35","author":"Badr","year":"2019","journal-title":"Semin Oncol Nurs"},{"key":"2026100722465797600_oyag381-B14","doi-asserted-by":"crossref","first-page":"e869","DOI":"10.1016\/j.jpainsymman.2024.01.027","article-title":"Effectiveness of dyadic advance care planning: a systematic review and meta-analysis","volume":"67","author":"Liu","year":"2024","journal-title":"J Pain Symptom Manage"},{"key":"2026100722465797600_oyag381-B15","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1097\/CCO.0000000000000835","article-title":"Dyadic psychosocial interventions for patients with cancer and their caregivers: an update","volume":"34","author":"Tiete","year":"2022","journal-title":"Curr Opin Oncol"},{"key":"2026100722465797600_oyag381-B16","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1136\/bmjspcare-2022-003525","article-title":"Decision-making in palliative care: patient and family caregiver concordance and discordance-systematic review and narrative synthesis","volume":"13","author":"Symmons","year":"2023","journal-title":"BMJ Support Palliat Care"},{"key":"2026100722465797600_oyag381-B17","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1002\/pon.6146","article-title":"Factors associated with cancer patients\u2019 distinct death-preparedness states","volume":"32","author":"Wen","year":"2023","journal-title":"Psychooncology"},{"key":"2026100722465797600_oyag381-B18","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1080\/07481187.2024.2305340","article-title":"Factors of preparedness for loss from cancer among Taiwanese family caregivers","volume":"48","author":"Wen","year":"2024","journal-title":"Death Stud"},{"key":"2026100722465797600_oyag381-B19","doi-asserted-by":"crossref","first-page":"1925","DOI":"10.1007\/s11136-017-1540-6","article-title":"Systematic review of caregiver responses for patient health-related quality of life in adult cancer care","volume":"26","author":"Roydhouse","year":"2017","journal-title":"Qual Life Res"},{"key":"2026100722465797600_oyag381-B20","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1002\/pon.5385","article-title":"Factors associated with prognostic awareness in patients with cancer: a systematic review","volume":"29","author":"Vlckova","year":"2020","journal-title":"Psychooncology"},{"key":"2026100722465797600_oyag381-B21","doi-asserted-by":"crossref","first-page":"301","DOI":"10.2147\/CMAR.S395259","article-title":"Prognostic awareness in terminally ill cancer patients: a narrative literature review of the processes involved","volume":"15","author":"Chichua","year":"2023","journal-title":"Cancer Manag Res"},{"key":"2026100722465797600_oyag381-B22","doi-asserted-by":"crossref","first-page":"1571","DOI":"10.1002\/pon.5458","article-title":"Hematological cancer patient-caregiver dyadic communication: a longitudinal examination of cancer communication concordance","volume":"29","author":"Siminoff","year":"2020","journal-title":"Psychooncology"},{"key":"2026100722465797600_oyag381-B23","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1089\/10966210260499014","article-title":"Initial assessment of a new measure of quality of life at the end of life (QUAL-E)","volume":"5","author":"Steinhauser","year":"2002","journal-title":"J Palliat Med"},{"key":"2026100722465797600_oyag381-B24","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1017\/S1478951504040027","article-title":"Measuring quality of life at the end of life: validation of the QUAL-E","volume":"2","author":"Steinhauser","year":"2004","journal-title":"Palliat Support Care"},{"key":"2026100722465797600_oyag381-B25","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1002\/pon.1995","article-title":"Preparation for the end of life in patients with advanced cancer and association with communication with professional caregivers","volume":"21","author":"Wentlandt","year":"2012","journal-title":"PsychoOncology"},{"key":"2026100722465797600_oyag381-B26","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1097\/00002820-197810000-00003","article-title":"Development of a symptom distress scale","volume":"1","author":"McCorkle","year":"1978","journal-title":"Cancer Nurs"},{"key":"2026100722465797600_oyag381-B27","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1002\/nur.4770030103","article-title":"Development of a social dependency scale","volume":"3","author":"Benoliel","year":"1980","journal-title":"Res Nurs Health"},{"key":"2026100722465797600_oyag381-B28","doi-asserted-by":"crossref","first-page":"2476","DOI":"10.1001\/jama.284.19.2476","article-title":"Factors considered important at the end of life by patients, family, physicians, and other care providers","volume":"284","author":"Steinhauser","year":"2000","journal-title":"JAMA"},{"key":"2026100722465797600_oyag381-B29","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1016\/0277-9536(91)90150-B","article-title":"The MOS social support survey","volume":"32","author":"Sherbourne","year":"1991","journal-title":"Soc Sci Med"},{"key":"2026100722465797600_oyag381-B30","doi-asserted-by":"crossref","first-page":"1433","DOI":"10.1002\/sim.1522","article-title":"A mixed-effects multinomial logistic regression model","volume":"22","author":"Hedeker","year":"2003","journal-title":"Stat Med"},{"key":"2026100722465797600_oyag381-B31","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1007\/978-3-319-12120-8_9","volume-title":"Family-Oriented Informed Consent: East Asian and American Perspectives","author":"Lee","year":"2015"},{"key":"2026100722465797600_oyag381-B32","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1093\/annonc\/mdp313","article-title":"Health care-related predictors of husbands\u2019 preparedness for the death of a wife to cancer\u2014a population-based follow-up","volume":"21","author":"Hauksdottir","year":"2010","journal-title":"Ann Oncol"},{"key":"2026100722465797600_oyag381-B33","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1016\/S1470-2045(07)70209-7","article-title":"Parents\u2019 intellectual and emotional awareness of their child\u2019s impending death to cancer: a population-based long-term follow-up study","volume":"8","author":"Valdimarsdottir","year":"2007","journal-title":"Lancet Oncol"},{"key":"2026100722465797600_oyag381-B34","doi-asserted-by":"crossref","first-page":"S54","DOI":"10.1038\/sj.embor.7400402","article-title":"Cultural aspects of time and ageing. Time is not the same in every culture and every circumstance; our views of aging also differ","volume":"6","author":"Helman","year":"2005","journal-title":"EMBO Rep"},{"key":"2026100722465797600_oyag381-B35","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s13690-020-00402-5","article-title":"The influence of education on health: an empirical assessment of OECD countries for the period 1995-2015","volume":"78","author":"Raghupathi","year":"2020","journal-title":"Arch Public Health"},{"key":"2026100722465797600_oyag381-B36","article-title":"Health literacy, information provision and satisfaction in advanced cancer consultations: two observational studies using level of education as a proxy","volume":"18","author":"van Vliet","year":"2021","journal-title":"BMJ Support Palliat Care."},{"key":"2026100722465797600_oyag381-B37","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1191\/0269216304pm891oa","article-title":"Awareness of husband\u2019s impending death from cancer and long-term anxiety in widowhood: a nationwide follow-up","volume":"18","author":"Valdimarsdottir","year":"2004","journal-title":"Palliat Med"},{"key":"2026100722465797600_oyag381-B38","doi-asserted-by":"crossref","first-page":"1665","DOI":"10.1001\/jama.300.14.1665","article-title":"Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment","volume":"300","author":"Wright","year":"2008","journal-title":"JAMA"},{"key":"2026100722465797600_oyag381-B39","doi-asserted-by":"crossref","first-page":"2509","DOI":"10.1002\/cncr.23476","article-title":"Peace, equanimity, and acceptance in the cancer experience (PEACE): validation of a scale to assess acceptance and struggle with terminal illness","volume":"112","author":"Mack","year":"2008","journal-title":"Cancer"},{"key":"2026100722465797600_oyag381-B40","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1080\/07481187.2023.2231388","article-title":"Preparedness for caregiving and preparedness for death: associations and modifiable thereafter factors among family caregivers of patients with advanced cancer in specialized home care","volume":"48","author":"H\u00e4ger Tibell","year":"2024","journal-title":"Death Stud"},{"key":"2026100722465797600_oyag381-B41","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1177\/0269216321999962","article-title":"Mutual support between patients and family caregivers in palliative care: a systematic review and narrative synthesis","volume":"35","author":"McCauley","year":"2021","journal-title":"Palliat Med"},{"key":"2026100722465797600_oyag381-B42","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1186\/s12889-021-10188-y","article-title":"Talking but not always understanding: couple communication about infertility concerns after cancer","volume":"21","author":"Hawkey","year":"2021","journal-title":"BMC Public Health"},{"key":"2026100722465797600_oyag381-B43","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1176\/appi.psy.41.6.500","article-title":"Prognostic awareness and the terminally ill","volume":"41","author":"Chochinov","year":"2000","journal-title":"Psychosomatics"},{"key":"2026100722465797600_oyag381-B44","doi-asserted-by":"crossref","first-page":"e2200266","DOI":"10.1200\/GO.22.00266","article-title":"Communication in cancer care in Asia: a narrative review","volume":"9","author":"Mori","year":"2023","journal-title":"JCO Glob Oncol."},{"key":"2026100722465797600_oyag381-B45","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1177\/02692163251317856","article-title":"Asian family members\u2019 participation in advance care planning: an integrative review","volume":"39","author":"Pan","year":"2025","journal-title":"Palliat Med"},{"key":"2026100722465797600_oyag381-B46","doi-asserted-by":"crossref","first-page":"3006","DOI":"10.1111\/jgs.18000","article-title":"Giving up on the objective of providing goal-concordant care: advance care planning for improving caregiver outcomes","volume":"70","author":"Fried","year":"2022","journal-title":"J Am Geriatr Soc"},{"key":"2026100722465797600_oyag381-B47","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1001\/jama.2021.23695","article-title":"Shifting to serious illness communication","volume":"327","author":"Jacobsen","year":"2022","journal-title":"JAMA"}],"container-title":["The Oncologist"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/oncolo\/advance-article-pdf\/doi\/10.1093\/oncolo\/oyag381\/71400391\/oyag381.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/oncolo\/article-pdf\/31\/11\/oyag381\/71400391\/oyag381.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/oncolo\/article-pdf\/31\/11\/oyag381\/71400391\/oyag381.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T02:47:12Z","timestamp":1791427632000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/oncolo\/article\/doi\/10.1093\/oncolo\/oyag381\/8836418"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,25]]},"references-count":47,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2026,10,7]]}},"URL":"https:\/\/doi.org\/10.1093\/oncolo\/oyag381","relation":{},"ISSN":["1083-7159","1549-490X"],"issn-type":[{"value":"1083-7159","type":"print"},{"value":"1549-490X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,11]]},"published":{"date-parts":[[2026,9,25]]},"article-number":"oyag381"}}