Factors associated with prognostic awareness in patients with cancer: A systematic review

Abstract

Objectives Prognostic awareness relates to patients' capacity to understand their prognosis and the likely illness trajectory. Based on the current evidence, accurate PA is associated with decrease in uncertainty, depresivity, and anxiety and with increase in quality of life. However, other studies found also negative associations of PA and quality of life and mental health. This systematic review synthesizes the available literature on factors associated with accurate prognostic awareness in patients with cancer. Methods Four databases were systematically searched for studies assessing prognostic awareness in patients with cancer. In these studies, we looked for factors positively or negatively associated with prognostic awareness. Included studies were critically appraised for methodological quality. Results We screened 28 078 studies and included 70. In these studies, 102 factors were found to be related to prognostic awareness positively or negatively. Identified factors were divided into seven groups: demographic factors, factors related to coping, health condition factors, psychological factors, factors associated with end‐of‐life care, factors related to communication, and factors related to relatives. Prognostic awareness differs according to age, personality, communication with doctor, disease stage, or being outpatient. For some factors such as depression, anxiety, or quality of life, higher level of these factors was found to be associated with accurate and inaccurate prognostic awareness. Conclusions Prognostic awareness is a complex phenomenon associated with various positive and negative associations for patients with cancer. Clinicians must consider individual preferences and values of patients and their families when discussing prognosis and must be prepared for potential adverse outcomes.

Prognostic awareness in advanced cancer patients and their caregivers: A longitudinal cohort study

“…The available evidence shows that strikingly low number of advanced cancer patients understand their prognosis well—the mean prevalence of accurate prognostic awareness in a recent large international meta‐analysis was 49.1% (95% CI: 42.7%–55.5%, range: 5.4%–85.7%) 7 —and most of them usually see their situation as overoptimistic compared to their physicians. Accepting the bad news and being able to make decisions reflecting the poor prognosis is a very complex process, involving a number of factors such as the patients' coping style, doctor/patient relationship, clinicians' communication skills or the hope and ability to accept the stage of the illness in family members 8,9 . At the same time, the available evidence shows that most patients prefer to be informed about their diagnosis and prognosis, even if it is poor, and their preferences for health information are not related to their level of prognostic awareness 10–12 .…”

“…Several studies also showed that accurate prognostic awareness can positively influence achieving goal‐concordant care at the end of life 13–15 . Although we could expect some specific factors being associated with prognostic awareness of patients in the Eastern Europe, recent systematic reviews did not find any research published on prognostic awareness from this region 6,7,9 …”

“…state in their landmark paper, “patients gradually develop prognostic awareness through an incremental cognitive and emotional process” (p. 894). With regard to this process and the gradual development of prognostic awareness, there is a striking lack of longitudinal research on prognostic awareness, with most studies reporting only cross‐sectional data 6,9 . Therefore the primary aim of this study was to analyse the possible changes in prognostic awareness of advanced cancer patients over time.…”

Association Between Quality of Life and Prognostic Awareness in Patients with Advanced Cancer

“…Having an accurate prognostic awareness can help patients to receive a goal-concordant end of life care [7], including higher chance of completing advance directives and having discussion about possible treatment options with physicians [8][9][10]. Effective communication is a necessary prerequisite for the development of accurate prognostic awareness, although many other factors such as age, education and patients' values also play an important role [4,[11][12][13]. Available evidence suggests that despite current standards of communication in oncology majority of patients with advanced cancer keep inaccurate perception of the curability of their condition and the goal of their treatment even while receiving palliative care [6, [14][15][16].…”

“…However, other studies reported that being aware of terminal condition may be a cause of psychological distress for patients, decreasing their quality of life, increasing anxiety and depression and even shorten survival [16,[23][24][25][26][27]. These contradictory ndings can be caused by the fact that available studies used different and often nonstandardized methods of how is prognostic awareness assessed, asking patients to identify their current health status or indicating the curability of their condition, using open-ended as well as closed questions or scales [6,11]. On comparison, assessing the quality of life and psychological distress represent less of a challenge as there is a wide range of standardized tools available for patients with advanced health conditions, including cancer [28].…”