Prognostic awareness in advanced cancer: an integrative literature review

Abstract

Individuals with advanced cancer who have accurate prognostic awareness are reported to make more informed decisions about their plan of care. Despite this, it is reported that individuals do not always have accurate prognostic awareness with the rationale for this discordance unclear. The primary aim of the integrative literature review was to identify if there is concordance between actual prognosis and accurate prognostic awareness in individuals with advanced cancer. The secondary aim was to identify the rationale for any discordance between actual prognosis and prognostic awareness in individuals with advanced cancer. This is an integrative literature review using a systematic approach. Literature searches were undertaken in March 2018 in four databases; CINAHL, MEDLINE, PsycINFO and Cochrane Library. Searches were limited to between 2008 and 2018 and those written in the English language. Database searches were supplemented with papers from reference lists of included papers and grey literature. Two reviewers independently completed the literature search and independently reviewed the papers. Fourteen eligible research papers were identified. The majority of individuals with advanced cancer in the included studies did not have accurate prognostic awareness. When identified, the rationale for discordance relates to the individual not being communicated accurate prognostic information, not being able to recall prognostic conversations or prognosis being discussed in vague terms. As individuals with advanced cancer with accurate prognostic awareness make more informed decisions at a crucial time in their life trajectory, it is imperative that healthcare professionals are equipped to effectively deliver accurate prognostic information, ensuring understanding is assessed.

Prevalence and Predictors of Physician-Patient Discordance in Prognostic Perceptions in Advanced Cancer

“… 1-12 Nevertheless, evidence suggests that between 25% and 100% of patients hold inaccurate perceptions of their prognosis, depending on the specific study sample and definition of (accurate) prognostic perceptions. 4 , 13-16 …”

Prognostic awareness and prognostic information preferences among advanced cancer patients in Kenya

“…Given the important role of prognostic awareness in providing patient-centred care, efforts to educate patients in Kenya on the value of this information should be a priority, especially among younger patients who were less likely to prefer prognostic information in our study. Interventions to address these concerns might include public health campaigns on the value of informed decision-making, provider training in health communication 31 and protocols requiring informed consent 32 and patient and provider education on advance care planning. Future research should test the effectiveness of these interventions in improving prognostic awareness.…”

Prognostic Awareness, Preferences for Prognostic Information, and Health-related Quality of Life Among Advanced Cancer Patients in Kenya

“…Given the necessity of prognostic awareness for achieving patient-centred care and meeting patient preferences [24], efforts to increase awareness among patients with advanced cancer in Kenya should be a priority, especially among patient subgroups that have been historically disenfranchised. This is likely best achieved through a multifactorial approach that includes greater emphasis on 1) public health campaigns on the value of informed decision-making, 2) provider training in health communication [25], 3) advanced care plans, and 4) protocols that necessitate The FACIT and all related works are owned and copyrighted by, and the intellectual property of David Cella, Ph.D. Permission for use of the FACT/FACIT system of questionnaire is obtained by contacting information@facit.org.…”