Hope, bias and survival expectations of advanced cancer patients: A cross‐sectional study

Abstract

Objective Many patients with advanced illness are unrealistically optimistic about their prognosis. We test for the presence of several cognitive biases, including optimism bias, illusion of superiority, self‐deception, misattribution, and optimistic update bias, that could explain unrealistically optimistic prognostic beliefs among advanced cancer patients and quantifies the extent to which hope exacerbates these biases. Methods A cross‐sectional survey was administered to 200 advanced cancer patients with physician‐estimated prognoses of one year or less. Hope was measured using the Herth Hope Index (HHI). Hypotheses were tested using linear and logistic regressions and a structural‐equation model. Results Results are consistent with the presence of optimism bias, illusion of superiority, self‐deception, and misattribution. All of these biases are amplified by higher levels of hope. Each 1‐point higher HHI is associated with a 6% (OR: 1.06; 95% CI: 1.01–1.11) greater odds of believing their illness is curable, a 0.33‐year (95% CI: 0.17–0.49) longer expected survival, a 6% (OR: 1.06; 95% CI: 1.02–1.11) higher probability of believing that survival outcomes are better than the average patient, a 5% higher odds of believing primary intent of treatment is curative (OR: 1.05; 95% CI: 1.00–1.10), and a 12% (OR: 1.12; 95% CI: 1.05–1.17) higher odds of believing they are well‐informed. Mediation analyses revealed that hope significantly mediates the effect of mental‐well‐being and loneliness on expected survival. Conclusions Results suggest advanced cancer patients succumb to several cognitive biases which are exacerbated by greater levels of hope. As a result, they are susceptible to possible over‐treatment and regret.

Report of the Lancet Commission on the Value of Death: bringing death back into life

“…209 A recent study of patients with advanced cancer confirms that higher levels of hope increase all these biases. 210 Carers, whose level of hope may exceed that of their loved ones, have these same biases.…”

What is the evidence for efficacy of advance care planning in improving patient outcomes? A systematic review of randomised controlled trials

“…Prognostic awareness is an important component of preparedness for end-of-life and can be a focus for future ACP studies among seriously ill patients. However, it may be difficult to achieve for patients with an unpredictable disease trajectory, and may be biased by patients’ hope and optimism for future 171…”

“…However, it may be difficult to achieve for patients with an unpredictable disease trajectory, and may be biased by patients’ hope and optimism for future. 171 …”

“…However, it may be difficult to achieve for patients with an unpredictable disease trajectory, and may be biased by patients' hope and optimism for future. 171 Another important aspect of end-of-life preparedness is nominating a surrogate decision-maker and discussing end-of-life care goals and preferences with the surrogate. Our review provides strong evidence that ACP facilitates congruence in preferences between patients and their surrogate, with interventions primarily involving communication.…”

Uncertainty and hope in relation to anxiety and depression in advanced lung cancer

“…As for hope, it has been related to lower levels of anxiety and depression. As hope increases, so does the belief that the disease can be cured and the expectation of survival 11…”