Associations of prognostic awareness/acceptance with psychological distress, existential suffering, and quality of life in terminally ill cancer patients' last year of life

Abstract

Knowing one's poor prognosis and confronting one's impending death without full acceptance and adequate professional psycho-spiritual support may harm more than benefit terminally ill cancer patients' psychological state, existential well-being, and QOL. These findings highlight the importance of tailoring psycho-spiritual support to cancer patients' psychological and existential needs when prognostic information is disclosed.

Patients’ understanding of treatment goals and disease course and their relationship with optimism, hope, and quality of life: a preliminary study among advanced breast cancer outpatients before receiving palliative treatment

“…A recent study conducted in Taiwan in 2015 reported that accurate prognostic awareness was associated with poorer QoL in terminally ill cancer patients' final year of life [11]. In our study, however, no statistically significant difference was determined between the subscales of QoL and patients' expectation of prognosis and awareness of treatment intent.…”

“…Yet, in many cultures, such as in collectivist Asian and Muslim cultures, illness is a shared family affair, and concealing the truth is a common practice, whereas in Western cultures, the disclosure of diagnosis and terminal prognosis is regarded as patient autonomy [8]. Relating to these issues, the prognostic awareness of patients with cancer has generated a growing interest among researchers [9][10][11][12][13]. However, the prevalence of disease prognosis and perception of treatment purpose were inconsistent in these studies.…”

Transitions in Prognostic Awareness Among Terminally Ill Cancer Patients in Their Last 6 Months of Life Examined by Multi-State Markov Modeling

“…Becoming accurately aware of one's poor prognosis is a dynamic process , but in a recent 34‐study systematic review of advanced/terminally ill cancer patients’ prognostic awareness , the majority of studies ( n = 22; 64.7%) used cross‐sectional surveys. Only a handful of longitudinal studies explored changes in patients’ prognostic awareness more than twice , with several methodological shortcomings. Few studies measured changes in cancer patients’ prognostic awareness until their death or last month of life .…”

“…Only a handful of longitudinal studies explored changes in patients’ prognostic awareness more than twice , with several methodological shortcomings. Few studies measured changes in cancer patients’ prognostic awareness until their death or last month of life . Some explored individual‐level changes in prognostic awareness , but none investigated transition probabilities in distinct states of prognostic awareness between consecutive time points.…”

“…Patients' desire and need for prognostic information is a key to accurate prognostic awareness [19,20]. However, desire for prognosis [21,22] and prognostic awareness [9][10][11][12][13][15][16][17][18] are often treated as isolated events and explored separately. To understand the process that terminally ill cancer patients go through to reach accurate prognostic awareness, a useful conceptual framework is the transtheoretical model (TTM) [23,24].…”