Outcomes of Prognostic Disclosure: Associations With Prognostic Understanding, Distress, and Relationship With Physician Among Patients With Advanced Cancer. Academic Article Article uri icon

Overview

MeSH

  • Adult
  • Advance Directives
  • Aged
  • Emotions
  • Female
  • Humans
  • Male
  • Middle Aged
  • Odds Ratio
  • Patient Preference
  • Prognosis
  • Terminal Care

MeSH Major

  • Comprehension
  • Life Expectancy
  • Neoplasms
  • Physician-Patient Relations
  • Stress, Psychological
  • Truth Disclosure

abstract

  • To determine how prognostic conversations influence perceptions of life expectancy (LE), distress, and the patient-physician relationship among patients with advanced cancer. This was a multicenter observational study of 590 patients with metastatic solid malignancies with progressive disease after ≥ one line of palliative chemotherapy, undergoing follow-up to death. At baseline, patients were asked whether their oncologist had disclosed an estimate of prognosis. Patients also estimated their own LE and completed assessments of the patient-physician relationship, distress, advance directives, and end-of-life care preferences. Among this cohort of 590 patients with advanced cancer (median survival, 5.4 months), 71% wanted to be told their LE, but only 17.6% recalled a prognostic disclosure by their physician. Among the 299 (51%) of 590 patients willing to estimate their LE, those who recalled prognostic disclosure offered more realistic estimates as compared with patients who did not (median, 12 months; interquartile range, 6 to 36 months v 48 months; interquartile range, 12 to 180 months; P < .001), and their estimates were less likely to differ from their actual survival by > 2 (30.2% v 49.2%; odds ratio [OR], 0.45; 95% CI, 0.14 to 0.82) or 5 years (9.5% v 35.5%; OR, 0.19; 95% CI, 0.08 to 0.47). In adjusted analyses, recall of prognostic disclosure was associated with a 17.2-month decrease (95% CI, 6.2 to 28.2 months) in patients' LE self-estimates. Longer LE self-estimates were associated with lower likelihood of do-not-resuscitate order (adjusted OR, 0.439; 95% CI, 0.296 to 0.630 per 12-month increase in estimate) and preference for life-prolonging over comfort-oriented care (adjusted OR, 1.493; 95% CI, 1.091 to 1.939). Prognostic disclosure was not associated with worse patient-physician relationship ratings, sadness, or anxiety in adjusted analyses. Prognostic disclosures are associated with more realistic patient expectations of LE, without decrements to their emotional well-being or the patient-physician relationship. © 2015 by American Society of Clinical Oncology.

publication date

  • November 10, 2015

has subject area

  • Adult
  • Advance Directives
  • Aged
  • Comprehension
  • Emotions
  • Female
  • Humans
  • Life Expectancy
  • Male
  • Middle Aged
  • Neoplasms
  • Odds Ratio
  • Patient Preference
  • Physician-Patient Relations
  • Prognosis
  • Stress, Psychological
  • Terminal Care
  • Truth Disclosure

Research

keywords

  • Journal Article
  • Multicenter Study
  • Observational Study

Identity

Language

  • eng

PubMed Central ID

  • PMC4737862

Digital Object Identifier (DOI)

  • 10.1200/JCO.2015.61.9239

PubMed ID

  • 26438121

Additional Document Info

start page

  • 3809

end page

  • 3816

volume

  • 33

number

  • 32