Transitions in Prognostic Awareness Among Terminally Ill Cancer Patients in Their Last 6 Months of Life Examined by Multi-State Markov Modeling

Chen, Chen Hsiu; Wen, Fur‐Hsing; Hou, Ming‐Mo; Hsieh, Ching-Hua; Chou, Wen‐Chi; Chen, Jen‐Shi; Chang, Wen‐Cheng; Tang, Siew Tzuh

doi:10.1634/theoncologist.2017-0068

Cited by 25 publications

(25 citation statements)

References 55 publications

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“…The most frequently used structured technique to measure prognostic awareness was Terminal Illness Acknowledgement tool 73 . This tool asks the patient following question: “How would you describe your current health status?” Patient can choose from three answers: (a) relatively healthy; (b) seriously but not terminally ill; (c) seriously and terminally ill 26,73 . The second most often used method was asking patients about the curability of their disease and offering three options to answer: (a) the disease is curable; (b) the disease might recur in the future; (c) the disease cannot be cured and they would probably die in future 9 .…”

Section: Resultsmentioning

confidence: 99%

“…Patients with accurate prognostic awareness received often preferred type of care 67 . On the other hand, patients with accurate PA tend to have shorter survival than patients with inaccurate PA 17, 23, 24, 26, 39, 44 . One study found that patients with accurate prognostic awareness waited longer from diagnosis for referral to palliative care 69 …”

Section: Resultsmentioning

confidence: 99%

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Factors associated with prognostic awareness in patients with cancer: A systematic review

Vlčková

Tučková

Poláková³

et al. 2020

Psycho-Oncology

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Objectives Prognostic awareness relates to patients' capacity to understand their prognosis and the likely illness trajectory. Based on the current evidence, accurate PA is associated with decrease in uncertainty, depresivity, and anxiety and with increase in quality of life. However, other studies found also negative associations of PA and quality of life and mental health. This systematic review synthesizes the available literature on factors associated with accurate prognostic awareness in patients with cancer. Methods Four databases were systematically searched for studies assessing prognostic awareness in patients with cancer. In these studies, we looked for factors positively or negatively associated with prognostic awareness. Included studies were critically appraised for methodological quality. Results We screened 28 078 studies and included 70. In these studies, 102 factors were found to be related to prognostic awareness positively or negatively. Identified factors were divided into seven groups: demographic factors, factors related to coping, health condition factors, psychological factors, factors associated with end‐of‐life care, factors related to communication, and factors related to relatives. Prognostic awareness differs according to age, personality, communication with doctor, disease stage, or being outpatient. For some factors such as depression, anxiety, or quality of life, higher level of these factors was found to be associated with accurate and inaccurate prognostic awareness. Conclusions Prognostic awareness is a complex phenomenon associated with various positive and negative associations for patients with cancer. Clinicians must consider individual preferences and values of patients and their families when discussing prognosis and must be prepared for potential adverse outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Factors associated with prognostic awareness in patients with cancer: A systematic review

Vlčková

Tučková

Poláková³

et al. 2020

Psycho-Oncology

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“…30 Patients in state 2 (not knowing but wanting to know) earnestly prepared for prognostic understanding by consciousness-raising to gather related information 30 as shown by our finding that they had the highest probability of shifting toward higher states of prognostic awareness and stayed the shortest time in that state among the four states of prognostic awareness. 22 However, in their struggle to seek prognostic information, they may not have had sufficient time (as they died in this state) to communicate their life-sustaining-treatment preferences to their physician, who could have clarified the benefit of life-sustaining treatments, and their families. This insufficient communication would have led to these patients receiving more aggressive life-sustaining treatments than they preferred than those with accurate prognostic awareness (data not shown), as reported.…”

Section: Discussionmentioning

confidence: 99%

“…Prognostic awareness was evaluated by asking patients if they knew their prognosis, and if so, whether their disease (1) was curable; (2) might recur in the future, but their life was not currently in danger; or (3) could not be cured, and they would probably die soon. 22 Only patients who chose option 3 were recognized as accurately understanding their prognosis. If patients indicated that they did not know their prognosis, they were then asked to rate their desire for prognostic information (i.e.…”

Section: Methodsmentioning

confidence: 99%

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Accurate prognostic awareness and preference states influence the concordance between terminally ill cancer patients’ states of preferred and received life-sustaining treatments in the last 6 months of life

et al. 2019

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Background: Factors facilitating/hindering concordance between preferred and received life-sustaining treatments may be distorted if preferences and predictors are measured long before death. Aim: To examine factors facilitating/hindering concordance between cancer patients’ preferred and received life-sustaining-treatment states in their last 6 months. Design: Longitudinal, observational design. Setting/participants: States of preferred and received life-sustaining treatments (cardio-pulmonary resuscitation, intensive care unit care, cardiac massage, intubation with mechanical ventilation, intravenous nutritional support, and nasogastric tube feeding) were examined in 218 Taiwanese cancer patients by a latent transition model with hidden Markov modeling. Multivariate logistic regression modeling was used to examine factors facilitating/hindering concordance between preferred and received life-sustaining-treatment states. Results: Concordance between preferred and received life-sustaining-treatment states was poor (40.8%, kappa value (95% confidence interval): 0.05 [–0.03, 0.14]). Patients who accurately understood their prognosis and preferred comfort care were significantly more likely to receive preferred life-sustaining treatments before death than those who did not know their prognosis but wanted to know, those who were uniformly uncertain about what life-sustaining treatments they preferred to receive, and those who preferred nutritional support but declined other life-sustaining treatments. Patient age, physician–patient end-of-life-care discussions, symptom distress, and functional dependence were not associated with concordance between preferred and received life-sustaining-treatment states. Conclusion: Prognostic awareness and preferred states of life-sustaining treatments were significantly associated with concordance between preferred and received life-sustaining-treatment states. Personalized interventions should be developed to cultivate terminally ill cancer patients’ accurate prognostic awareness, allowing them to formulate realistic life-sustaining-treatment preferences and facilitating their receiving value-concordant end-of-life care.

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Factors associated with distinct prognostic‐awareness‐transition patterns over cancer patients’ last 6 months of life

et al. 2021

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Background Cancer patients may develop prognostic awareness (PA) heterogeneously, but predictors of PA‐transition patterns have never been studied. We aimed to identify transition patterns of PA and their associated factors during cancer patients’ last 6 months. Methods For this secondary‐analysis study, PA was assessed among 334 cancer patients when they were first diagnosed as terminally ill and monthly till they died. PA was categorized into four states: (a) unknown and not wanting to know; (b) unknown but wanting to know; (c) inaccurate awareness; and (d) accurate awareness. The first and last PA states estimated by hidden Markov modeling were examined to identify their change patterns. Factors associated with distinct PA‐transition patterns were determined by multinomial logistic regressions focused on modifiable time‐varying variables assessed in the wave before the last PA assessment to ensure a clear time sequence for associating with PA‐transition patterns. Results Four PA‐transition patterns were identified: maintaining accurate PA (56.3%), gaining accurate PA (20.4%), heterogeneous PA (7.8%), and still avoiding PA (15.6%). Reported physician‐prognostic disclosure increased the likelihood of belonging to the maintaining‐accurate‐PA group than to other groups. Greater symptom distress predisposed patients to be in the still‐avoiding‐PA than the heterogeneous PA group. Patients with higher functional dependence and more anxiety/depressive symptoms were more and less likely to be in the heterogeneous PA group and in the still‐avoiding‐PA group, respectively, than in the maintaining‐ and gaining‐accurate PA groups. Conclusions Cancer patients heterogeneously experienced PA‐transition patterns over their last 6 months. Physicians’ prognostic disclosure, and patients’ symptom distress, functional dependence, and anxiety/depressive symptoms, all modifiable by high‐quality end‐of‐life care, were associated with distinct PA‐transition patterns.

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Transitions in Prognostic Awareness Among Terminally Ill Cancer Patients in Their Last 6 Months of Life Examined by Multi-State Markov Modeling

Cited by 25 publications

References 55 publications

Factors associated with prognostic awareness in patients with cancer: A systematic review

Factors associated with prognostic awareness in patients with cancer: A systematic review

Accurate prognostic awareness and preference states influence the concordance between terminally ill cancer patients’ states of preferred and received life-sustaining treatments in the last 6 months of life

Factors associated with distinct prognostic‐awareness‐transition patterns over cancer patients’ last 6 months of life

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