Patient and caregiver agreement on prognosis estimates for older adults with advanced cancer

Abstract

BACKGROUND: Disagreements between patients and caregivers about treatment benefits, care decisions, and patients' health are associated with increased patient depression as well as increased caregiver anxiety, distress, depression, and burden. Understanding the factors associated with disagreement may inform interventions to improve the aforementioned outcomes. METHODS: For this analysis, baseline data were obtained from a cluster-randomized geriatric assessment trial that recruited patients aged ≥70 years who had incurable cancer from community oncology practices (University of Rochester Cancer Center 13070; Supriya G. Mohile, principal investigator). Patient and caregiver dyads were asked to estimate the patient's prognosis. Response options were 0 to 6 months, 7 to 12 months, 1 to 2 years, 2 to 5 years, and >5 years. The dependent variable was categorized as exact agreement (reference), patientreported longer estimate, or caregiver-reported longer estimate. The authors used generalized estimating equations with multinomial distribution to examine the factors associated with patient-caregiver prognostic estimates. Independent variables were selected using the purposeful selection method. RESULTS: Among 354 dyads (89% of screened patients were enrolled), 26% and 22% of patients and caregivers, respectively, reported a longer estimate. Compared with dyads that were in agreement, patients were more likely to report a longer estimate when they screened positive for polypharmacy (β = 0.81; P = .001), and caregivers reported greater distress (β = 0.12; P = .03). Compared with dyads that were in agreement, caregivers were more likely to report a longer estimate when patients screened positive for polypharmacy (β = 0.82; P = .005) and had lower perceived self-efficacy in interacting with physicians (β = −0.10; P = .008). CONCLUSIONS: Several patient and caregiver factors were associated with patient-caregiver disagreement about prognostic estimates. Future studies should examine the effects of prognostic disagreement on patient and caregiver outcomes.

Association BetweenCaregiver-OncologistDiscordance in Patient's Life Expectancy Estimates and Caregiver Perceived Autonomy Support by the Oncologist

“…For comparison, among the 372/414 patient‐oncologist dyads, 73.9% ( n = 275) were discordant. Among the 354/414 patient‐caregiver dyads with available data, 48% ( n = 170) were discordant [40].…”

Assessing the burden of family caregivers of cancer patients: a cross-sectional study

“…In this study, it was found that most caregivers (66.4%) were female. Other studies with family caregivers of people with cancer also indicate that they mainly comprise women [17][18][19] . This fact can be attributed to the historical context in which women are primarily responsible for domestic care, as shown in another study 20 .…”

Decision Making in Older Adults With Cancer

“…Assessment of prognostic understanding may occur in the forms of treatment goal or intent, illness perception, curability, and survival. [87][88][89][90] Studies have demonstrated that 50%-73% of older adults with advanced cancer have poor prognostic understanding or that their prognostic understanding differs from that of their oncologist. 87,89,91 In addition, 48%-52% of caregivers of older adults with advanced cancer have differing prognostic understanding from that of the patients and their oncologists.…”

“…87,89,91 In addition, 48%-52% of caregivers of older adults with advanced cancer have differing prognostic understanding from that of the patients and their oncologists. 88,89 Poor patient prognostic understanding is associated with receipt of more aggressive care such as chemotherapy at the end of life. 92 In addition, differing prognostic understanding between patients and their caregivers may be associated with lower utilization of hospice services.…”