Attitudes Toward Striving for Quality and Length of Life Among Patients With Advanced Cancer and a Poor Prognosis

Abstract

PURPOSE: When deliberating palliative cancer treatment, insight into patients' attitudes toward striving for quality of life (QL) and length of life (LL) may facilitate goal-concordant care. We investigated the (1) attitudes of patients with advanced cancer toward striving for QL and/or LL and whether these change over time, and (2) characteristics associated with these attitudes (over time). METHODS: We performed a secondary analysis of a randomized controlled trial on improving shared decision making (SDM), without differentiation between intervention arms. Patients (n = 173) with advanced cancer, a median life expectancy of < 12 months without anticancer treatment, and a median survival benefit of < 6 months from systemic therapy were included in seven Dutch hospitals. We used audio-recorded consultations and surveys at baseline (T0), shortly after the consultation (T2), at 3 and 6 months (T3 and T4). Primary outcomes were patients' attitudes toward striving for QL and LL (Quality Quantity Questionnaire; T2, T3, and T4). RESULTS: Overall, patients' attitudes toward striving for QL became less positive over 6 months ( P < .01); attitudes toward striving for LL did not change on group level. Studying individual patients, 76% showed changes in their attitudes toward striving for QL and/or LL at some point during the study, which occurred in various directions. More helplessness/hopelessness ( P < .001), less fighting spirit ( P < .05), less state anxiety ( P < .001), and more observed SDM ( P < .05) related to more positive attitudes toward striving for QL. Lower education, less helplessness/hopelessness, more fighting spirit, and more state anxiety ( P < .001) related to more positive attitudes toward striving for LL. CONCLUSION: Oncologists may explore patients' attitudes toward striving for QL and LL repeatedly and address patients' coping style and emotions during SDM to facilitate goal-concordant care throughout the last phase of life.

Prevalence and Predictors of Physician-Patient Discordance in Prognostic Perceptions in Advanced Cancer

“…Fighting spirit may enable patients to deal with their disease by seeing cancer as a challenge, but could also be maladaptive when the end of life is near. 95 , 96 …”

Implementation of Best Practices in Pancreatic Cancer Care in the Netherlands

“…The small increase in palliative chemotherapy may be due to the poor condition of patients at the time of diagnosis, rather than poor implementation of guidelines. It should be noted that because OS is limited and disease-related symptoms often lead to a poor performance status, it is quite conceivable that in the process of clinical evaluation and shared decision-making best supportive care is indeed the best option for some patients . Therefore, future research should focus on identifying which patients correctly and incorrectly not receive any chemotherapy and the reasons for this.…”

“…It should be noted that because OS is limited and disease-related symptoms often lead to a poor performance status, it is quite conceivable that in the process of clinical evaluation and shared decision-making best supportive care is indeed the best option for some patients. 24 , 25 Therefore, future research should focus on identifying which patients correctly and incorrectly not receive any chemotherapy and the reasons for this. The value of liquid or tumor biomarkers for predicting the effectivity of different chemotherapy regimens seems essential.…”

Patient-Reported Outcome Measures to Improve the Care Continuum for Patients With Metastatic Breast Cancer: Opportunities and Implications for Nursing Practice

“…Perspectives on prioritizing optimal HRQoL versus prolonging survival tend to evolve over time in patients with poor prognoses. 39 Through systematic and regular HRQoL and symptom burden monitoring, PROMs offer opportunities to revisit the suitability and relevance of therapy. That is, more patients who are followed-up in palliative care discontinued chemotherapy in the last 6 to 2 weeks of life compared to those who were not.…”

“…18 PROMs in clinical practice have shown potential in improving patientÀphysician communication (SMD 0.36, 95% CI 0.21À0.52; 5 studies; 658 participants). 28 As women encounter insufficient preparation for moments of decline and end-of-life care, 13,19 we believe that the information derived from monitoring of HRQoL and symptom burden could support the ongoing conversations about goals of care 39 and better prepare patients for the various transitions within the care continuum.…”