Prognostic Awareness and the Terminally Ill

Chochinov, Harvey Max; Tataryn, Douglas J.; Wilson, Keith G.; Enns, Murray W.; Lander, Sheila

doi:10.1176/appi.psy.41.6.500

Cited by 161 publications

(179 citation statements)

References 27 publications

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“…[13][14][15][16][17] Such avoidance can lead to poorer patient satisfaction and psychological morbidity. 18,19 If information provision is not honest and detailed, patients may perceive that health care professionals are withholding potentially frightening information. 20,21 When cancer patients are not adequately informed of their prognosis, they are more likely to choose aggressive anticancer treatments 22 and make decisions that they later regret.…”

Section: The Guidelinesmentioning

confidence: 99%

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Life expectancy discussions in a multisite sample of Australian medical oncology outpatients

Zucca

Sanson‐Fisher

Waller

et al. 2015

Medical Journal of Australia

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Objectives: The study examined: 1) the proportion of patients who received their preferred level of information about life expectancy; and 2) sociodemographic, clinical and psychological factors associated with patients' perceptions of whether they received too little, too much, or the right amount of information about life expectancy. Design: Cross‐sectional survey. Setting: Eleven large Australian medical oncology treatment centres. Participants: A total of 1431 medical oncology outpatients participated (81% consent rate). Eligible patients were approached between September 2012 and May 2014. Main outcome measures: Patients indicated whether the information about life expectancy they received aligned with their preferences. Results: Almost one in four patients (24%) received too little information, 4% received too much, and 50% received all the information they wanted; 22% of patients neither wanted nor received information about life expectancy. Patients were more likely to receive too little information if they were not in remission (odds ratio [OR], 1.77), did not know their cancer stage at diagnosis (OR, 3.64), or were anxious (OR, 1.48) or depressed (OR, 1.48). Patients had greater odds of receiving too much information if they were younger (OR, 1.45), had more advanced cancer (OR, 2.01) or did not know their cancer stage at diagnosis (OR, 4.42). Conclusions: That fact that 28% of cancer patients did not receive their desired level of information about life expectancy highlights the difficulties associated with discussing this sensitive topic. To ensure that life expectancy discussions correspond with patient preferences, clinicians should routinely ask patients whether they want to know this information, in what format, and at which level of detail.

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Section: The Guidelinesmentioning

confidence: 99%

“…8 In addition, awareness of prognosis is associated with greater satisfaction with care and lower depression levels in patients. 18,19 Timing of prognostic and end-of-life discussions (Box 1)…”

Section: The Guidelinesmentioning

confidence: 99%

Life expectancy discussions in a multisite sample of Australian medical oncology outpatients

Zucca

Sanson‐Fisher

Waller

et al. 2015

Medical Journal of Australia

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“…4,5 Acknowledgment of a terminal prognosis is also known to help many patients and physicians better manage the death process and has been associated with less emotional patient distress. 6,7 In addition, withholding prognostic information to those who are terminally ill is deemed ethically unacceptableeven being viewed as a form of deception. 8,9 Despite this information, problems persist regarding how prognosis information should be disclosed to terminally ill patients, and many physicians have been described as hesitant to communicate prognoses to the terminally ill. 6,10 Given that the majority of cancer-related deaths typically occur with some amount of anticipation, with median survival times of 9 to 12 months having been described for many advanced or terminally ill cancer patient populations, 11,12 there would seem to be sufficient opportunities for meaningful physician disclosure of a terminal prognosis to take place with such patients.…”

Section: Introductionmentioning

confidence: 99%

What Are Terminally Ill Cancer Patients Told About Their Expected Deaths? A Study of Cancer Physicians’ Self-Reports of Prognosis Disclosure

Daugherty

Hlubocky

2008

JCO

137

128

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A B S T R A C T PurposeLittle is known about how physicians discuss prognosis with terminally ill cancer patients. Thus, we sought to obtain cancer physicians' self-reports of their prognosis communication practices. MethodsA survey seeking self-reports regarding prognosis communication with their terminally ill cancer patients was mailed to a systematic sample of medical oncologists in the United States. ResultsOf 1,137 physicians, 729 completed and returned surveys (64% response rate). Median age of respondents was 51 years (range, 33 to 80 years); 82% were men. Respondents had practiced cancer care for a median of 18 years (range, 1.5 to 50 years) and reported seeing a median of 60 patients per week (range, 0 to 250 patients per week). Although 98% said their usual practice is to tell terminally ill patients that they will die, 48% specifically described communicating terminal prognoses to patients only when specific preferences for prognosis information were expressed. Forty-three percent said they always or usually communicate a medical estimate of time as to when death is likely to occur, and 57% reported sometimes, rarely, or never giving a time frame. Seventy-three percent said prognosis communication education was either absent or inadequate during their training, and 96% believed it should be part of cancer care training. ConclusionMedical oncologists report routinely informing their terminally ill patients that they will die. However, they are divided in describing themselves as either always discussing a terminal prognosis or doing so if it is consistent with their patients' preferences for prognostic information. Most medical oncologists say they do not routinely communicate an estimated survival time to their patients.

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“…Alternatively, the differences in perspectives may relate to the medical school training itself, as suggested by recent work by Walden-Galuszko et al [6][7] reporting that first-year medical students' concept of a good death was traditional (i.e., dying at home and surrounded by loved ones) whereas medical professionals who were further along in their training conceptualized a good death as fast, sudden, and with good symptom control. Other factors that have been found to influence one's concept of a good death are having witnessed someone else's death, 8 one's cultural heritage, 9,10 having an accurate assessment of one's prognosis, 11 having an accurate understanding of the utility of life-sustaining treatments for one's actual situation, 12 and having engaged in advance care planning. 13 Thus, one's concept of a good death may be changeable with time, role, and experience.…”

Section: Introduction Tmentioning

confidence: 99%

Validation of a New Measure of Concept of a Good Death

Schwartz

Mazor

Rogers

et al. 2003

Journal of Palliative Medicine

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Background:The concept of a good death is central to end-of-life care research. Despite its importance and the high interest in the topic, there are few measures currently available for use in clinical research.Purpose: The present work describes the development and testing of a set of items intended to measure the importance of several components posited to be critical to the concept of a good death. It is intended for use with health care providers and lay people in the context of end-of-life care research and education.Population: Four cohorts (n 5 596) were recruited to participate, representing two helping profession disciplines, nonhelping professionals, and a range of ages, specifically: (1) undergraduate medical students; (2) master's degree students in nursing; (3) graduate students from the life sciences; and (4) practicing hospice nurses.Methods: Participants completed self-report questionnaires at baseline and retest. Psychometric analyses included item frequency distributions, factor analysis, a reliability, intraclass correlation, and measures of association.Results: The new Concept of a Good Death measure demonstrated good item frequency distributions, acceptable internal consistency reliability, and test-retest stability. Its factor structure revealed that three distinct domains are measured, reflecting the psychosocial/spiritual, physical, and clinical aspects of a good death. An examination of patterns of correlations showed differential associations with death anxiety, spiritual beliefs and practices, anxious mood, and sociodemographic characteristics.Conclusions: The new Concept of a Good Death instrument appears to measure three distinct factors which people consider important to a Good Death. Ratings of the importance of these factors are reliable and valid. The instrument has the advantage of being a brief, selfreport index for use in end-of-life care research.

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Prognostic Awareness and the Terminally Ill

Cited by 161 publications

References 27 publications

Life expectancy discussions in a multisite sample of Australian medical oncology outpatients

Life expectancy discussions in a multisite sample of Australian medical oncology outpatients

What Are Terminally Ill Cancer Patients Told About Their Expected Deaths? A Study of Cancer Physicians’ Self-Reports of Prognosis Disclosure

Validation of a New Measure of Concept of a Good Death

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