Impact of “four-step” death education on life quality and negative emotions in advanced esophageal cancer patients and families

Table 1 Baseline data of patients and caregivers, mean ± SD/n (%)

Index	SC group (n = 127)	FDE group (n = 108)	t/χ2	P value
Age	58.73 ± 6.83	59.41 ± 6.78	0.770	0.442
Gender			0.183	0.669
Female	31 (24.41)	29 (26.85)
Male	96 (75.59)	79 (73.15)
BMI	22.36 ± 1.84	22.19 ± 1.68	0.707	0.480
Marital status(married)	109 (85.83)	100 (92.59)	2.715	0.099
Smoking history	38 (29.92)	33 (30.56)	0.011	0.916
Alcohol consumption history	91 (71.65)	77 (71.30)	0.004	0.952
Education level			0.374	0.830
Elementary school or below	35 (27.56)	26 (24.07)
Junior high school/high school	59 (46.46)	53 (49.07)
University or above	33 (25.98)	29 (26.85)
Nutritional status			0.004	0.998
Grade A	19 (14.96)	16 (14.81)
Grade B	96 (75.59)	82 (75.93)
Grade C	12 (9.45)	10 (9.26)
Serum albumin	30.51 ± 3.37	31.08 ± 3.44	1.285	0.200
Hypertension	21 (16.54)	15 (13.89)	0.315	0.575
Diabetes	12 (9.45)	10 (9.26)	0.002	0.960
Family history	43 (33.86)	36 (33.33)	0.007	0.932
Duration of illness (months)	3.16 ± 0.65	3.23 ± 0.69	0.768	0.443
Primary tumor location			0.038	0.981
Esophagus/gastroesophageal junction (I, II)	101 (79.53)	85 (78.70)
Gastroesophageal junction III/cardia	14 (11.02)	12 (11.11)
Gastric/sub-cardia/stomach	12 (9.45)	11 (10.19)
ECOG status			0.002	0.962
1	78 (61.42)	66 (61.11)
2	49 (38.58)	42 (38.89)
Disease stage			0.001	0.970
III	92 (72.44)	78 (72.22)
IV	35 (27.56)	30 (27.78)
Surgical objectives			0.315	0.575
Curative surgery	38 (29.92)	36 (33.33)
Palliative surgery	89 (70.08)	72 (66.67)
Types of surgery			0.203	0.904
Minimally invasive	53 (41.73)	46 (42.59)
Open surgery	26 (20.47)	24 (22.22)
Hybrid minimally invasive	48 (37.80)	38 (35.19)
Blood loss (mL)	322.81 ± 98.47	325.26 ± 101.68	0.187	0.852
Resection margins (< 1 mm)			0.042	0.979
Free (R0)	72 (56.69)	61 (56.48)
Involved (R1)	46 (36.22)	40 (37.04)
R2	9 (7.09)	7 (6.48)
Postoperative complications
Anastomotic leak	7 (5.51)	5 (4.63)	0.094	0.759
Pulmonary infection	10 (7.87)	7 (6.48)	0.169	0.681
Recurrent laryngeal nerve injury	4 (3.15)	3 (2.78)	0	1.000
Surgical duration (minutes)	214.63 ± 41.36	211.43 ± 37.72	0.614	0.540
Length of hospital stay (days)	14.28 ± 2.83	13.96 ± 3.12	0.833	0.406
Family member information
Age	43.25 ± 8.14	42.72 ± 8.26	0.496	0.620
Gender			0.060	0.806
Female	97 (76.38)	81 (75.00)
Male	30 (23.62)	27 (25.00)
Relationship to patient			0.071	0.790
Spouse/partner	79 (62.20)	69 (63.89)
Child	48 (37.80)	39 (36.11)
Employment status			0.618	0.734
Employed	50 (39.37)	48 (44.44)
Retired	41 (32.28)	32 (29.63)
Unemployed	36 (28.35)	28 (25.93)

BMI: Body mass index; ECOG: Eastern Cooperative Oncology Group; SC: Standard care; FDE: Four-step death education.

Table 2 Patient symptom domain quality of life scores, mean ± SD

Index	SC group (n = 127)	FDE group (n = 108)	t/χ2	P value
Pre-intervention symptoms
Fatigue	67.33 ± 7.43	68.04 ± 7.21	0.743	0.458
Nausea and vomiting	72.14 ± 3.55	72.59 ± 3.89	0.922	0.358
Pain	87.28 ± 6.44	88.11 ± 6.18	1.007	0.315
Dyspnea	62.56 ± 6.34	63.62 ± 6.59	1.259	0.209
Insomnia	83.66 ± 7.35	84.23 ± 7.49	0.586	0.558
Loss of appetite	58.95 ± 4.57	59.23 ± 4.43	0.468	0.640
Constipation	59.67 ± 5.72	60.33 ± 5.45	0.896	0.371
Diarrhea	43.89 ± 6.33	44.17 ± 5.48	0.351	0.726
Financial difficulty	40.33 ± 4.42	40.67 ± 4.39	0.591	0.555
Post-intervention symptoms
Fatigue	62.68 ± 6.40	61.03 ± 6.12	2.003	0.046
Nausea and vomiting	63.84 ± 4.56	62.53 ± 4.75	2.165	0.031
Pain	77.16 ± 5.18	76.23 ± 4.84	1.417	0.158
Dyspnea	51.32 ± 5.86	50.67 ± 5.19	0.887	0.376
Insomnia	75.13 ± 5.61	73.57 ± 5.46	2.152	0.032
Loss of appetite	42.61 ± 6.56	40.88 ± 5.78	2.131	0.034
Constipation	47.13 ± 5.82	46.65 ± 5.67	0.640	0.523
Diarrhea	37.59 ± 4.36	36.72 ± 4.22	1.555	0.121
Financial difficulty	36.15 ± 4.82	35.67 ± 4.69	0.768	0.443

SC: Standard care; FDE: Four-step death education.

Table 3 Patient family quality of life, mean ± SD

Index	SC group (n = 127)	FDE group (n = 108)	t/χ2	P value
Pre-intervention
Family activities	18.35 ± 2.48	18.14 ± 2.52	0.639	0.523
Emotional support	9.52 ± 1.98	9.41 ± 2.03	0.440	0.661
Economic status	17.83 ± 1.96	17.78 ± 1.86	0.205	0.838
Family member satisfaction	11.39 ± 1.55	11.42 ± 1.62	0.106	0.916
Post-intervention
Family activities	21.66 ± 2.73	22.39 ± 2.65	2.057	0.041
Emotional support	13.21 ± 2.37	13.89 ± 2.42	2.194	0.029
Economic status	18.23 ± 2.03	18.25 ± 1.96	0.055	0.956
Family member satisfaction	13.36 ± 1.61	13.84 ± 1.59	2.321	0.021

SC: Standard care; FDE: Four-step death education.

Table 4 Caregiver family quality of life, mean ± SD

Index	SC group (n = 127)	FDE group (n = 108)	t/χ2	P value
Pre-intervention
Family activities	19.29 ± 2.65	19.26 ± 2.49	0.092	0.927
Emotional support	10.61 ± 1.79	10.69 ± 1.75	0.357	0.721
Economic status	18.02 ± 2.11	18.11 ± 2.09	0.332	0.740
Family member satisfaction	10.37 ± 1.92	10.32 ± 1.89	0.199	0.842
Post-intervention
Family activities	23.35 ± 2.37	24.01 ± 2.29	2.174	0.031
Emotional support	14.34 ± 1.99	14.85 ± 1.87	2.039	0.043
Economic status	18.87 ± 2.32	18.96 ± 2.14	0.293	0.770
Family member satisfaction	13.55 ± 1.23	13.92 ± 1.28	2.249	0.025

SC: Standard care; FDE: Four-step death education.

Table 5 Caregiver burden perception, mean ± SD

Index	SC group (n = 127)	FDE group (n = 108)	t/χ2	P value
Pre-intervention
Emotional burden	37.57 ± 3.01	37.74 ± 2.92	0.437	0.663
Time-dependent burden	6.73 ± 0.51	6.67 ± 0.54	0.986	0.325
Developmental burden	6.52 ± 0.56	6.57 ± 0.48	0.871	0.384
Social burden	6.41 ± 0.77	6.45 ± 0.63	0.378	0.706
Pre-intervention
Emotional burden	29.66 ± 2.45	28.91 ± 2.61	2.288	0.023
Time-dependent burden	6.27 ± 0.54	6.11 ± 0.56	2.237	0.026
Developmental burden	6.16 ± 0.65	5.99 ± 0.61	2.025	0.044
Social burden	6.33 ± 0.64	6.29 ± 0.63	0.449	0.654

SC: Standard care; FDE: Four-step death education.

Table 6 Negative emotions, mean ± SD

Index	SC group (n = 127)	FDE group (n = 108)	t/χ2	P value
Patient
SAS before	48.39 ± 5.75	48.36 ± 5.69	0.039	0.969
SAS after	42.63 ± 5.17	40.88 ± 5.03	2.626	0.009
SDS before	51.26 ± 5.53	51.28 ± 5.29	0.018	0.986
SDS after	48.87 ± 5.31	47.19 ± 5.27	2.423	0.016
Caregiver
SAS before	52.42 ± 5.51	52.12 ± 5.42	0.425	0.671
SAS after	45.19 ± 4.81	43.83 ± 4.72	2.187	0.030
SDS before	41.15 ± 4.95	41.21 ± 4.98	0.098	0.922
SDS after	38.78 ± 4.15	37.45 ± 4.26	2.422	0.016

SAS: Self-Rating Anxiety Scale; SDS: Self-Rating Depression Scale; SC: Standard care; FDE: Four-step death education.