Prognostic awareness and its association with health outcomes in the last year of life

Özdemir, Semra; Chaudhry, Isha; Ng, Sean; Teo, Irene; Malhotra, Chetna; Finkelstein, Eric A.

doi:10.1002/cam4.5286

Cited by 8 publications

(6 citation statements)

References 35 publications

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“…A review by Kylma et al further showed that hope is related to temporal factors such as pain and quality of life (Kylm et al, 2009 ). Prognostic beliefs have also been shown to change over time (Ozdemir et al, 2023 ) and may be influenced by both health status and prior treatment decisions (Finkelstein et al, 2021 ). For example, Echarte et al proposed that self-deception entails a lower cognitive load than accepting the truth and argues that, as a result, patients can become more hopeful as illness progresses (Echarte et al, 2016 ).…”

Section: Discussionmentioning

confidence: 99%

The relationship between hope, medical expenditure and survival among advanced cancer patients

et al. 2023

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IntroductionAmong those with advanced illness, higher levels of hope may offer physiological benefits. Yet, greater levels of hope may also encourage aggressive treatments. Therefore, higher levels of hope may lead to greater healthcare utilization, higher expenditure, and longer survival. We test these hypotheses among patients with advanced cancer.MethodsA secondary data analysis from a cross-sectional survey of 195 advanced cancer patients with high mortality risk linked to subsequent healthcare utilization (outpatient, day surgeries, non-emergency admissions), health expenditures, and death records. The survey collected data on hope, measured generally by the Herth Hope Index (HHI) and more narrowly by two questions on illness-related hope. Generalized linear regression and Cox models were used to test our hypotheses.Results142 (78%) survey participants died during the period of analysis, with close to half (46%) doing so within a year of the survey. Contrary to expectation, HHI scores did not have a significant association with healthcare utilization, expenditure or survival. Yet, illness-related hope, defined as those who expected to live at least 2 years, as opposed to the likely prognosis of 1 year or less as determined by the primary treating oncologist, had 6.6 more planned hospital encounters (95% CI 0.90 to 12.30) in the 12-months following the survey and 41% lower mortality risk (hazard ratio: 0.59, 95% CI 0.36 to 0.99) compared to those who were less optimistic. Secondary analysis among decedents showed that patients who believed that the primary intent of their treatment is curative, had higher total expenditure (S$30,712; 95% CI S$3,143 to S$58,282) in the last 12 months of life than those who did not have this belief.ConclusionWe find no evidence of a relationship between a general measure of hope and healthcare utilization, expenditure, or survival among advanced cancer patients. However, greater illness-related hope is positively associated with these outcomes.

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Section: Discussionmentioning

confidence: 99%

The relationship between hope, medical expenditure and survival among advanced cancer patients

et al. 2023

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“…Their prognostic beliefs can also change over time with changes in their symptoms, even if the two are unrelated. This indicates some cognitive dissonance among patients 16,17 . ACP conversations have the potential to educate patients and their caregivers about their (patients') illnesses.…”

Section: Figurementioning

confidence: 99%

“…This indicates some cognitive dissonance among patients. 16,17 ACP conversations have the potential to educate patients and their caregivers about their (patients') illnesses. These conversations should happen continually to address patients' evolving health conditions, prognosis, and cognitive dissonance.…”

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confidence: 99%

Advance care planning: It is time to rethink our goals

Malhotra

2023

J American Geriatrics Society

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“…8 While rates of inaccurate prognostic understanding can be attributed to healthcare provider discomfort with communication around prognosis and death (particularly when treating Latino patients), 9 much of this variability is also attributed to a lack of consensus around how best to conceptualize and measure prognostic understanding. Historically, studies have examined prognostic understanding in terms of only one of its components, 6 typically focusing on a patients' awareness of the terminal nature of the disease, 10,11 their beliefs about curability, 12,13 or estimated life expectancy. 14 Of those studies that have focused on more than one facet of prognosis, [15][16][17][18][19][20] few have included all aspects or used a well-validated measure of prognostic understanding.…”

Section: Introductionmentioning

confidence: 99%

“…Historically, studies have examined prognostic understanding in terms of only one of its components, 6 typically focusing on a patients’ awareness of the terminal nature of the disease, 10,11 their beliefs about curability, 12,13 or estimated life expectancy. 14 Of those studies that have focused on more than one facet of prognosis, 15–20 few have included all aspects or used a well-validated measure of prognostic understanding.…”

Section: Introductionmentioning

confidence: 99%

How patients with advanced cancer conceptualize prognosis: A phenomenological qualitative inquiry

et al. 2023

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Background: Despite the importance of accurate prognostic understanding in patients with advanced cancer, there is little consensus around how to conceptualize and measure the multidimensional construct. Most studies focus on single aspects of prognostic understanding (e.g., curability) that clinicians have identified as important; no previous research has asked patients how they define “prognosis.” Aim: The present study examined how patients with advanced cancer conceptualize their “prognosis.” It also explored how patients assigned value to prognostic information and the impact of prognosis on life perspectives. Design: A phenomenological approach was used to analyze semi-structured interviews with individuals with advanced cancer to examine how patients define prognosis. Setting/participants: English and Spanish-speaking patients with advanced cancer ( N = 29) were recruited from ambulatory clinics at a comprehensive cancer center in New York City. Results: To conceptualize prognosis, patients focused on concrete medical data, anticipated survival and quality of life, impact on meaningful life events, uncertainty, and physician affect. They discussed the importance of maintaining normalcy despite prognosis, knowledge as a form of coping, information reframing, and altered decision-making as means of coping with prognostic information. Conclusions: Given the range of ways patients define prognosis and assign value to prognostic information, clinicians should incorporate a thorough assessment of patient information preferences, values, and coping styles when engaging in end-of-life discussions. Trainings should emphasize the importance of nonverbal cues (i.e., affect management, body language) in prognostic disclosure.

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Prognostic awareness and its association with health outcomes in the last year of life

Cited by 8 publications

References 35 publications

The relationship between hope, medical expenditure and survival among advanced cancer patients

The relationship between hope, medical expenditure and survival among advanced cancer patients

Advance care planning: It is time to rethink our goals

How patients with advanced cancer conceptualize prognosis: A phenomenological qualitative inquiry

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