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Mathews J, Merchant S, Galica J, Palmer MJ, O'Donnell J, Koven R, Booth C, Brundage M. Measuring prognostic awareness in patients with advanced cancer: a scoping review and interpretive synthesis of the impact of hope. J Natl Cancer Inst 2024; 116:506-517. [PMID: 38134429 DOI: 10.1093/jnci/djad267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Assessment of prognostic awareness (PA) in patients with advanced cancer is challenging because patient responses often indicate their hopes. The objectives of this scoping review were to summarize studies that measured PA in patients with advanced cancer and to synthesize data about how PA was measured and whether hope was incorporated into the measurement. METHODS MEDLINE and Embase databases were searched from inception to December 14, 2021. Data regarding the impact of hope on assessment of PA were extracted when studies reported on patients' beliefs about prognosis and patients' beliefs about their doctor's opinion about prognosis. An interpretive synthesis approach was used to analyze the data and to generate a theory regarding the incorporation of hope into the assessment of PA. RESULTS In total, 52 studies representing 23 766 patients were included. Most were conducted in high-income countries and measured PA based on the goal of treatment (curable vs incurable). Five studies incorporated hope into the assessment of PA and reported that among patients who responded that their treatment goal was a cure, an average of 30% also acknowledged that their doctors were treating them with palliative intent. Interpretive synthesis of the evidence generated a trinary conceptualization of PA patients who are aware and accepting of their prognosis; aware and not accepting; and truly unaware. Each of these groups will benefit from different types of interventions to support their evolving PA. CONCLUSION The trinary conceptualization of PA may promote understanding of the impact of hope in the assessment of PA and guide future research.
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Affiliation(s)
- Jean Mathews
- Division of Palliative Medicine, Department of Medicine, Queen's University, Kingston, ON, Canada
- Department of Oncology, Queen's University, Kingston, ON, Canada
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, ON, Canada
| | - Shaila Merchant
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, ON, Canada
- Division of General Surgery and Surgical Oncology, Queen's University, Kingston, ON, Canada
| | - Jacqueline Galica
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, ON, Canada
- School of Nursing, Queen's University, Kingston, ON, Canada
| | - Michael J Palmer
- Department of Oncology, Queen's University, Kingston, ON, Canada
| | - Jennifer O'Donnell
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, ON, Canada
| | - Rachel Koven
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, ON, Canada
| | - Christopher Booth
- Department of Oncology, Queen's University, Kingston, ON, Canada
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, ON, Canada
| | - Michael Brundage
- Department of Oncology, Queen's University, Kingston, ON, Canada
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Davis C, Wagner AK, Salcher-Konrad M, Scowcroft H, Mintzes B, Pokorny AMJ, Lew J, Naci H. Communication of anticancer drug benefits and related uncertainties to patients and clinicians: document analysis of regulated information on prescription drugs in Europe. BMJ 2023; 380:e073711. [PMID: 36990506 PMCID: PMC10053600 DOI: 10.1136/bmj-2022-073711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
OBJECTIVE To evaluate the frequency with which relevant and accurate information about the benefits and related uncertainties of anticancer drugs are communicated to patients and clinicians in regulated information sources in Europe. DESIGN Document content analysis. SETTING European Medicines Agency. PARTICIPANTS Anticancer drugs granted a first marketing authorisation by the European Medicines Agency, 2017-19. MAIN OUTCOME MEASURES Whether written information on a product addressed patients' commonly asked questions about: who and what the drug is used for; how the drug was studied; types of drug benefit expected; and the extent of weak, uncertain, or missing evidence for drug benefits. Information on drug benefits in written sources for clinicians (summaries of product characteristics), patients (patient information leaflets), and the public (public summaries) was compared with information reported in regulatory assessment documents (European public assessment reports). RESULTS 29 anticancer drugs that received a first marketing authorisation for 32 separate cancer indications in 2017-19 were included. General information about the drug (including information on approved indications and how the drug works) was frequently reported across regulated information sources aimed at both clinicians and patients. Nearly all summaries of product characteristics communicated full information to clinicians about the number and design of the main studies, the control arm (if any), study sample size, and primary measures of drug benefit. None of the patient information leaflets communicated information to patients about how drugs were studied. 31 (97%) summaries of product characteristics and 25 (78%) public summaries contained information about drug benefits that was accurate and consistent with information in regulatory assessment documents. The presence or absence of evidence that a drug extended survival was reported in 23 (72%) summaries of product characteristics and four (13%) public summaries. None of the patient information leaflets communicated information about the drug benefits that patients might expect based on study findings. Scientific concerns about the reliability of evidence on drug benefits, which were raised by European regulatory assessors for almost all drugs in the study sample, were rarely communicated to clinicians, patients, or the public. CONCLUSIONS The findings of this study highlight the need to improve the communication of the benefits and related uncertainties of anticancer drugs in regulated information sources in Europe to support evidence informed decision making by patients and their clinicians.
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Affiliation(s)
- Courtney Davis
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - Anita K Wagner
- Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | | | - Henry Scowcroft
- Alzheimer's Research UK, Cambridge, UK
- National Cancer Research Institute Bladder and Renal Research Group, London, UK
| | - Barbara Mintzes
- School of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
| | - Adrian M J Pokorny
- School of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
- Alice Springs Hospital, Northern Territory, Australia
| | - Jianhui Lew
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Huseyin Naci
- Department of Health Policy, London School of Economics and Political Science, London, UK
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Navarro Jiménez JM, Cruzado JA, Dominguez Cruz A, García García B, Horando López Y, Boya Cristia MJ. Los deseos de información en pacientes con cáncer avanzado. PSICOONCOLOGIA 2022. [DOI: 10.5209/psic.80803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objetivo: Comprobar los deseos de información, y las variables asociadas a ello, en los pacientes con cáncer avanzado atendidos por un Equipo de Soporte Hospitalario de Cuidados Paliativos. Método: Noventa pacientes con cáncer avanzado, fueron evaluados, mediante una entrevista estructurada sobre si tenían información sobre su enfermedad de los siguientes tipos: diagnóstico, curación, gravedad, objetivos del tratamiento y final de vida, y de su deseo de tener información en cada uno de esto cinco tipos de información. Además, se recogieron los datos sociodemográficos y clínicos, y se administraron: la Escala de Capacidad Funcional, el Índice de Comorbilidad de Charlson, y la Escala de Ansiedad y Depresión Hospitalaria. Resultados. Los resultados muestraron que la mayoría de los pacientes estaban informados del diagnóstico, y de la gravedad, pero no de los objetivos de tratamiento, la curación y el final de vida. De los pacientes no informados el 77,8% (14) deseaban conocer el diagnostico, el 60,0% (11) la gravedad, el 77,8% (35) el objetivo del tratamiento, el 76,7% (24) la curación y un 34,4% (10) el final de vida. Las variables asociadas al deseo de: a) información diagnóstica fueron: tener un cuidador principal más joven (p=,023); con pareja (p=,018), no religiosos (p=,025) y mayor número de visitas a urgencias (p=,004); b) información sobre gravedad fueron: ser joven (p=,009); con pareja (p=,04), y mejor estado ánimo (p=,009); c). Información sobre objetivos del tratamiento: ser joven (p=,001), Con pareja (p=,04), mejor estado ánimo (p=,001). d) información sobre curación: ser hombre (p=,018), con pareja (p=,04), no religiosos (p=,023). En el caso de información sobre el tiempo de vida no se encontró ninguna diferencia significativa. Conclusiones: es necesario valorar los deseos información que tienen los pacientes de forma individualizada y en las diferentes variables de información, y por ello la creación de una herramienta estandarizada en futuras investigaciones es una prioridad. La mayoría de los pacientes con cáncer avanzado están informados del diagnóstico y gravedad, pero existe un déficit de información en curación, objetivos del tratamiento y especialmente en la información del final de vida y destaca más aun, que un alto porcentaje de los pacientes no informados sí desearían recibir información, principalmente sobre los objetivos del tratamiento, sobre todo los más jóvenes, con pareja y no religiosos y con mejor estado de ánimo. Una calidad asistencial óptima en pacientes con cáncer avanzado requiere cubrir sus deseos de información.
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Wancata LM, Billingsley KG, Pailet J, Mayo SC, Sheppard BC, Hansen L. The patient's perspective: a qualitative study of individual experience with decision-making, treatment, and recovery for resectable pancreatic cancer. Support Care Cancer 2021; 30:2581-2589. [PMID: 34807295 DOI: 10.1007/s00520-021-06690-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 11/08/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Pancreatic ductal adenocarcinoma cancer (PDAC) remains a challenging diagnosis. The likelihood of long-term survival is limited even for patients who undergo maximal medical therapy with systemic chemotherapy and surgical resection. Within this intensive process, there remains limited understanding of patients' pretreatment expectations of PDAC treatment experience and their decision-making process. METHODS PDAC patients who underwent chemotherapy and surgical resection were retrospectively identified. Semi-structured phone interviews were completed regarding patient experience with therapy. Qualitative descriptive analysis was performed, and categories, subcategories, and themes were determined. RESULTS Fifteen patients were interviewed regarding their experience with PDAC treatment. An overall personal disease trajectory experience was identified with two phases. The first phase encompassed the patients' treatment. In this phase, patients expressed a choice, non-choice regarding therapy decisions, viewing therapy as the only option. Misconceptions about the roles of therapies and expected experience of treatment were observed. The second phase focused on life after therapy. Patients reported persistent physical changes secondary to therapy. An overall realistic understanding of the patient's limited prognosis was observed, with patients expressing appreciation of the life time gained as a benefit of treatment. CONCLUSIONS There remains critical areas for improvement in communication and care of patients with PDAC. Physicians should continue to ensure that patient's goals and wishes are respected when making treatment decisions and confirm that patients understand the roles and limitations of prescribed therapies. Additionally, patients continue to have significant physical changes post treatment which should be assessed for and managed as appropriate to maintain quality of life.
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Affiliation(s)
- Lauren M Wancata
- Virginia Mason Franciscan Health, 1100 Ninth Ave, C6-GS, WA, 98101, Seattle, USA.
| | - Kevin G Billingsley
- Yale School of Medicine, New Haven, CT, USA.,Department of Surgery, Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | - Jasmina Pailet
- Department of Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Skye C Mayo
- Department of Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Brett C Sheppard
- Department of Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Lissi Hansen
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
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Gal R, Oostinga D, Wessels H, Verlaan JJ, Charest-Morin R, Fisher CG, Verkooijen HM, Versteeg AL. Pre-treatment expectations of patients with spinal metastases: what do we know and what can we learn from other disciplines? A systematic review of qualitative studies. BMC Cancer 2020; 20:1212. [PMID: 33298017 PMCID: PMC7724808 DOI: 10.1186/s12885-020-07683-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/23/2020] [Indexed: 02/08/2023] Open
Abstract
Background Little is known about treatment expectations of patients with spinal metastases undergoing radiotherapy and/or surgery. Assuming that patients with spinal metastases share characteristics with patients who had spinal surgery for non-cancer related conditions and with advanced cancer patients, we performed a systematic review to summarize the literature on patient expectations regarding treatment outcomes of spinal surgery and advanced cancer care. Methods A comprehensive search was performed in MEDLINE, EMBASE and PsycINFO for studies between 2000 and sep-2019. Studies including adult patients (> 18 years), undergoing spinal surgery or receiving advanced cancer care, investigating patients’ pre-treatment expectations regarding treatment outcomes were included. Two independent reviewers screened titles, abstracts and full-texts, extracted data and assessed methodological quality. Results The search identified 7343 articles, of which 92 were selected for full-text review. For this review, 31 articles were included. Patients undergoing spinal surgery had overly optimistic expectations regarding pain and symptom relief, they underestimated the probability of functional disability, and overestimated the probability of (complete) recovery and return to work. Studies highlighted that patients feel not adequately prepared for surgery in terms of post-treatment expectations. Similarly, advanced cancer patients receiving palliative treatment often had overly optimistic expectations regarding their survival probability and cure rates. Conclusions Patients tend to have overly optimistic expectations regarding pain and symptom relief, recovery and prognosis following spinal surgery or advanced cancer care. Pretreatment consultation about the expected pain and symptom relief, recovery and prognosis may improve understanding of prognosis, and promote and manage expectations, which, in turn, may lead to better perceived outcomes. Trial registration PROSPERO registration number: CRD42020145151. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-020-07683-7.
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Affiliation(s)
- R Gal
- Division of Imaging and Cancer, University Medical Center Utrecht, University of Utrecht, Heideberglaan 100, 3584, CG, Utrecht, the Netherlands.
| | - D Oostinga
- Department of Orthopaedic Surgery, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - H Wessels
- Department of Corporate Communications, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J J Verlaan
- Department of Orthopaedic Surgery, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - R Charest-Morin
- Department of Orthopaedics, Division of Spine, Vancouver General Hospital/University of British Columbia, Vancouver, British Columbia, Canada
| | - C G Fisher
- Department of Orthopaedics, Division of Spine, Vancouver General Hospital/University of British Columbia, Vancouver, British Columbia, Canada
| | - H M Verkooijen
- Division of Imaging and Cancer, University Medical Center Utrecht, University of Utrecht, Heideberglaan 100, 3584, CG, Utrecht, the Netherlands
| | - A L Versteeg
- Division of Imaging and Cancer, University Medical Center Utrecht, University of Utrecht, Heideberglaan 100, 3584, CG, Utrecht, the Netherlands
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Boudewyns V, Southwell BG, DeFrank JT, Ferriola-Bruckenstein K, Halpern MT, O'Donoghue AC, Sullivan HW. Patients' understanding of oncology clinical endpoints: A literature review. PATIENT EDUCATION AND COUNSELING 2020; 103:1724-1735. [PMID: 32273145 PMCID: PMC7423743 DOI: 10.1016/j.pec.2020.03.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 02/13/2020] [Accepted: 03/18/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Oncology clinical trials use a variety of clinical endpoints. Patients' understanding of the differences between clinical endpoints is important because misperceptions of treatment efficacy may affect treatment decisions. The objective of this literature review is to find and synthesize available empirical publications assessing patients' understanding of common oncology clinical endpoints. METHODS We conducted a literature search of 5 databases and 3 conferences, limiting the search to articles and abstracts published in English through September 2018. We reviewed the titles and abstracts for inclusion, then reviewed full texts to determine if they reported empirical research studies focused on (1) clinical endpoints, (2) oncology, and (3) patient understanding. The original search identified 497publications, of which 13 met the inclusion criteria. RESULTS Available literature yields little information on this topic.The few publications that do exist suggest that healthcare professionals and cancer patients generally do not discuss clinical endpoint concepts and that patients can be confused about the purpose of a treatment based on misperceptions about endpoints. CONCLUSIONS Research is needed on how to discuss oncology clinical endpoints with patients. PRACTICE IMPLICATIONS Patient-friendly definitions of clinical endpoints may help healthcare providers communicate important information about treatments to patients.
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Sullivan HW, O'Donoghue AC, Ferriola-Bruckenstein K, Tzeng JP, Boudewyns V. Patients' Understanding of Oncology Clinical Endpoints: Environmental Scan and Focus Groups. Oncologist 2020; 25:1060-1066. [PMID: 32799406 DOI: 10.1634/theoncologist.2020-0402] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/06/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Understanding treatment options is important for patients with cancer and their caregivers. This may be difficult, however, because oncology treatments are often approved based on complex clinical endpoints. The study aimed to explore lay understanding of oncology clinical endpoints by assessing the definitions of clinical endpoints available online and gathering qualitative focus group data on cancer survivors' and the general public's understanding of clinical endpoints. METHODS We conducted an environmental scan to find Web sites accessible by a general audience that defined three clinical endpoints: overall survival, progression-free survival, and response rate. Next, we conducted a series of eight focus groups across the U.S. with cancer survivors (n = 36) and general population adults (n = 36). RESULTS We found several online resources defining each endpoint; however, many of the definitions we identified used technical language that may not be easily understood by patients and caregivers. Few focus group participants were familiar with the technical terms for these endpoints. When presented with the endpoint terms and definitions, participants had misconceptions about treatment efficacy. Specifically, they tended to expect that all endpoints were a variation on living longer. CONCLUSION The results point to the need for more patient-friendly definitions of clinical endpoints developed with input from the general public and from patients with cancer. IMPLICATIONS FOR PRACTICE As the number of oncology prescription drug approvals and the advertising of those drugs to consumers increase, it is timely and critical to understand how to discuss treatment benefits with patients. Patient-friendly definitions of common clinical endpoints, such as overall survival and progression-free survival, would help health care providers describe treatment benefits to patients. This research provides evidence regarding patients' understanding of these endpoints and suggests definitions for additional research. This represents a first step in creating evidence-based patient-friendly language to describe clinical endpoints.
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Affiliation(s)
| | | | | | - Janice P Tzeng
- RTI International, Research Triangle Park, North Carolina, USA
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8
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Vlckova K, Tuckova A, Polakova K, Loucka M. Factors associated with prognostic awareness in patients with cancer: A systematic review. Psychooncology 2020; 29:990-1003. [DOI: 10.1002/pon.5385] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/25/2020] [Accepted: 03/27/2020] [Indexed: 01/07/2023]
Affiliation(s)
- Karolina Vlckova
- Center for Palliative Care Prague Czech Republic
- First Faculty of MedicineCharles University Prague Czech Republic
| | - Anna Tuckova
- Center for Palliative Care Prague Czech Republic
- Faculty of Social SciencesCharles University Prague Czech Republic
| | | | - Martin Loucka
- Center for Palliative Care Prague Czech Republic
- Third Faculty of MedicineCharles University Prague Czech Republic
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Association of illness understanding with advance care planning and end-of-life care preferences for advanced cancer patients and their family members. Support Care Cancer 2019; 28:2959-2967. [DOI: 10.1007/s00520-019-05174-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
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DeMartini J, Fenton JJ, Epstein R, Duberstein P, Cipri C, Tancredi D, Xing G, Kaesberg P, Kravitz RL. Patients' Hopes for Advanced Cancer Treatment. J Pain Symptom Manage 2019; 57:57-63.e2. [PMID: 30261227 PMCID: PMC6310622 DOI: 10.1016/j.jpainsymman.2018.09.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/12/2018] [Accepted: 09/14/2018] [Indexed: 01/06/2023]
Abstract
CONTEXT Little is known about the hopes patients with advanced (incurable) cancer have for their treatment. OBJECTIVES The objective of this study was to describe the treatment hopes of advanced cancer patients, factors associated with expressing specific hopes, and the persons with whom hopes are discussed. METHODS We surveyed 265 advanced cancer patients in the U.S. about their hopes for treatment at the baseline and after three months. We developed a taxonomy of hopes for treatment, which two investigators used to independently code patient responses. We explored associations between hopes for cure and patient covariates. RESULTS We developed eight categories of hopes. We were able to apply these codes reliably, and 95% of the patient's responses fit at least one hope category. The hope categories in order of descending baseline prevalence were as follows: quality of life, life extension, tumor stabilization, remission, milestone, unqualified cure, control not otherwise specified, and cure tempered by realism. Most patients reported discussing hopes with partners, family/friends, and oncologists; a minority reported discussing hopes with nurses, primary care physicians, clergy, or support groups. In logistic regression analysis, unqualified hopes for cure were more likely in younger patients and in those who did not endorse discussing their hopes with primary care physicians. CONCLUSION Advanced cancer patients harbor a range of treatment hopes. These hopes often are not discussed with key members of the health care team. Younger age and lack of discussion of hopes with primary care physicians may lead to less realistic hopes for cure.
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Affiliation(s)
- Jeremy DeMartini
- Department of Psychiatry, University of California, Davis, Sacramento, California, USA.
| | - Joshua J Fenton
- Department of Family and Community Medicine, University of California, Davis, Sacramento, California, USA; Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California, USA
| | - Ronald Epstein
- Department of Family Medicine, University of Rochester, Rochester, New York, USA; Department of Psychiatry, University of Rochester, Rochester, New York, USA; Wilmot Cancer Center, University of Rochester, Rochester, New York, USA; Department of Medicine, University of Rochester, Rochester, New York, USA
| | - Paul Duberstein
- Department of Family Medicine, University of Rochester, Rochester, New York, USA; Department of Psychiatry, University of Rochester, Rochester, New York, USA
| | - Camille Cipri
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California, USA
| | - Daniel Tancredi
- Department of Pediatrics, University of California, Davis, Sacramento, California, USA
| | - Guibo Xing
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California, USA
| | - Paul Kaesberg
- Division of Hematology and Oncology, University of California, Davis, Sacramento, California, USA
| | - Richard L Kravitz
- Division of General Medicine, University of California, Davis, Sacramento, California, USA; Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California, USA
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11
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Monga V, Maliske SM, Kaleem H, Mott SL, K D Zamba G, Milhem M. Discrepancy between treatment goals documentation by oncologists and their understanding among cancer patients under active treatment with chemotherapy. Eur J Cancer Care (Engl) 2018; 28:e12973. [PMID: 30511450 DOI: 10.1111/ecc.12973] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 08/09/2018] [Accepted: 10/27/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE/BACKGROUND Discussion of treatment goals between oncologists and patients is challenging. Patients frequently misunderstand goals of therapy. There are several methods to document goals of chemotherapy, however, and are frequently not incorporated into patient charts. METHODS/DESIGN Cancer patients receiving their first cycle of chemotherapy were interviewed. Patients' recall of discussions with their oncologist regarding therapy intent was assessed and compared to documentation. An adjusted McNemar's test was utilised. A one-sample proportion test was used to evaluate whether the overall observed rate of discordance was significantly different from the proposed 33% rate; a rate posited as a threshold too high in the clinical sense. RESULTS Two hundred and seven eligible patients were interviewed. Oncologist identified treatment goals were not documented in 24.6% of cases and had to be excluded. There was not a significant difference in the directionality of discordance present. Inter-rater agreement between patient and oncologist was found to be adequate (κ = 0.64). The overall rate of discordance (17.29%) was found to be significantly less than the proposed acceptable level of 33% (p < 0.01). Upon univariable analysis, age, gender, marital and employment status were not found to be associated with discordance. CONCLUSIONS Discordance between treatment goals documentation and their understanding exists, indicating continued miscommunication between the patient and oncologist.
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Affiliation(s)
- Varun Monga
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Seth M Maliske
- Aspirus Wausau Hospital Regional Cancer Center, Wausau, Wisconsin
| | - Hassan Kaleem
- Division of Hematology and Oncology, Texas Tech University, Lubbock, Texas
| | - Sarah L Mott
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa
| | - Gideon K D Zamba
- Department of Biostatistics, University of Iowa, Iowa City, Iowa
| | - Mohammed Milhem
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, University of Iowa Carver College of Medicine, Iowa City, Iowa
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Bremer A, Dahné T, Stureson L, Årestedt K, Thylén I. Lived experiences of surviving in‐hospital cardiac arrest. Scand J Caring Sci 2018; 33:156-164. [DOI: 10.1111/scs.12616] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 08/02/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Anders Bremer
- Faculty of Health and Life Sciences Linnaeus University Kalmar/Växjö Sweden
- Division of Emergency Medical Services Kalmar County Council Kalmar Sweden
| | - Tova Dahné
- Department of Surgical Sciences Anaesthesiology and Intensive Care Akademiska Hospital Uppsala University Uppsala Sweden
- Department of Medical and Health Sciences Linköping University Linköping Sweden
| | - Lovisa Stureson
- Department of Anaesthesiology and Intensive Care, and Department of Medical and Health Sciences Linköping University Linköping Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences Linnaeus University Kalmar/Växjö Sweden
- The Research Section Kalmar County Council Kalmar Sweden
| | - Ingela Thylén
- Departments of Cardiology and Medical and Health Sciences Linköping University Linköping Sweden
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Augustussen M, Timm H, Hounsgaard L. Palliation til kræftpatienter i Grønland – set fra sundhedsprofessionelles perspektiv. ACTA ACUST UNITED AC 2018. [DOI: 10.18261/issn.1892-2686-2018-03-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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14
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Evaluation of decision support tools for patients with advanced cancer: A systematic review of literature. Palliat Support Care 2018; 17:356-364. [DOI: 10.1017/s1478951518000512] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveMedical decisions in the context of advanced cancer are more based on patient values and preferences than during the early stages of the disease. The implementation of shared decision-making is particularly important with an oncology palliative care population. However, few decision support tools focus on this population. This literature review aims to identify decision support tools related to palliative care for an oncological population and to assess their quality using International Patient Decision Aids Standards criteria.MethodThe tools were identified through PsycINFO, EMBASE, MEDLINE, and CINAHL databases; the inventory of tools to assist the decisions of the Ottawa Hospital Research Institute; and through the register of Cochrane trials. They were then evaluated using the third version of the International Patient Decision Aids Standards instrument.ResultSixteen tools were identified, which targeted five types of cancer and addressed a particular decision or the use of chemotherapy in addition to palliative care. The quality of the reviewed tools varies.Significance of resultsClinicians can use four decision support tools related to palliative care with an oncology population that meet a certain quality standard. Further studies are needed to develop new decision support tools targeting more types of cancer and decisions.
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Sato T, Soejima K, Fujisawa D, Takeuchi M, Arai D, Nakachi I, Naoki K, Kawada I, Yasuda H, Ishioka K, Nukaga S, Kobayashi K, Masaki K, Inoue T, Hikima K, Nakamura M, Ohgino K, Oyamada Y, Funatsu Y, Terashima T, Miyao N, Sayama K, Saito F, Sakamaki F, Betsuyaku T. Prognostic Understanding at Diagnosis and Associated Factors in Patients with Advanced Lung Cancer and Their Caregivers. Oncologist 2018; 23:1218-1229. [PMID: 30120158 DOI: 10.1634/theoncologist.2017-0329] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 02/21/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Prognostic understanding in advanced cancer patients and their caregivers may have an impact on the delivery of effective care. The aims of this study were to explore prognostic understanding at diagnosis in both patients with advanced lung cancer and their caregivers and to investigate correlates of their understanding. SUBJECTS, MATERIALS, AND METHODS A total of 193 patients with newly diagnosed advanced lung cancer and their 167 caregivers were enrolled at 16 hospitals in Japan. We assessed their perceptions of prognosis and goals of therapy and examined their associations with their sociodemographic characteristics, clinical status, quality of life, mood symptoms, and the status of disclosure of information by their treating physicians. RESULTS One fifth of patients and caregivers (21.7% and 17.6%, respectively) mistakenly believed that the patients' cancer was "completely curable." Substantial proportions of them (16.9% and 10.3%, respectively) mistakenly believed that the primary goal of therapy was to remove all the cancer. Levels of anxiety and depression in both patients and caregivers were significantly higher among those who had accurate understanding of prognosis. In multivariate analyses, inaccurate perceptions of prognosis in patients were associated with sex, better emotional well-being, and lower lung cancer-specific symptom burden. Caregivers' inaccurate perceptions of patients' prognoses were associated with better performance status and better emotional well-being of patients. CONCLUSION Substantial proportions of advanced lung cancer patients and their caregivers misunderstood their prognosis. Interventions to improve their accurate prognostic understanding should be developed with careful attention paid to its associated factors. IMPLICATIONS FOR PRACTICE This study demonstrated that substantial proportions of patients with newly diagnosed advanced lung cancer and their caregivers had misunderstandings about their prognosis. Accurate perceptions of prognosis, which are indispensable in the delivery of effective care, were associated with elevated levels of anxiety and depression in both patients and caregivers, warranting psychosocial care and support for them immediately after diagnosis. Inaccurate perceptions of prognosis in patients were associated with better emotional well-being and lower lung cancer-specific symptom burden. Illness understanding in caregivers was associated with patients' physical and mental status. Those findings provide insight into how they obtain accurate illness understanding.
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Affiliation(s)
- Takashi Sato
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Internal Medicine, Sano-kosei General Hospital, Sano, Japan
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Kenzo Soejima
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
- Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Daisuke Fujisawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
- Palliative Care Center, Keio University Hospital, Tokyo, Japan
| | - Mari Takeuchi
- Palliative Care Center, Keio University Hospital, Tokyo, Japan
| | - Daisuke Arai
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
- Pulmonary Division, Internal Medicine, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Ichiro Nakachi
- Pulmonary Division, Internal Medicine, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Katsuhiko Naoki
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Ichiro Kawada
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hiroyuki Yasuda
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kota Ishioka
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shigenari Nukaga
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Keigo Kobayashi
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Katsunori Masaki
- Pulmonary Division, Internal Medicine, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Takashi Inoue
- Department of Internal Medicine, Sano-kosei General Hospital, Sano, Japan
| | - Kota Hikima
- Department of Internal Medicine, Sano-kosei General Hospital, Sano, Japan
| | - Morio Nakamura
- Department of Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Keiko Ohgino
- Department of Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Yoshitaka Oyamada
- Department of Respiratory Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Yohei Funatsu
- Department of Respiratory Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Takeshi Terashima
- Department of Respiratory Medicine, Tokyo Dental College, Chiba, Japan
| | - Naoki Miyao
- Department of Respiratory Medicine, Nippon Kokan Hospital, Kanagawa, Japan
| | | | - Fumitake Saito
- Department of Pulmonary Medicine, Eiju General Hospital, Tokyo, Japan
| | - Fumio Sakamaki
- Division of Pulmonary Medicine, Department of Medicine, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Tomoko Betsuyaku
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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Yennurajalingam S, Lu Z, Prado B, Williams JL, Lim KH, Bruera E. Association between Advanced Cancer Patients' Perception of Curability and Patients' Characteristics, Decisional Control Preferences, Symptoms, and End-of-Life Quality Care Outcomes. J Palliat Med 2018; 21:1609-1616. [PMID: 30048214 DOI: 10.1089/jpm.2018.0186] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND There are limited studies on factors associated with cancer patients' perception of curability. OBJECTIVE To examine advanced cancer patient's perception of curability and its association with patient's sociodemographic and clinical characteristics, decisional control preference (DCP), symptoms, and end-of-life quality care outcomes. DESIGN Secondary analysis of a study to determine the DCP and illness understanding of advanced cancer patients receiving palliative care (PC). MEASUREMENTS Data of the Illness Understanding survey, the Control Preference Scale, and demographics, symptoms, and end-of-life quality care outcomes were reviewed. RESULTS Of 121 patients, 104 (86%) were evaluable. Median age was 56 years, 60% were women, and 64% had a Karnofsky performance status ≤60. Thirty-seven percent inaccurately reported that their cancer was curable. Patients with accurate perception were more likely to choose a passive DCP (20% vs. 2.6%, p = 0.04). An accurate perception of curability was associated with a longer time from advanced cancer diagnosis to PC referral (odds ratio [OR] = 1.04, p = 0.04). There was a trend toward an association between inaccurate perception of curability, male gender (OR = 0.29, p = 0.09), and intensive care unit admission within 30 days of death (OR = 0.26, p = 0.09). No other significant associations between perception of curability and patients' demographics, clinical characteristics, symptoms, or end-of-life quality care outcomes were found. CONCLUSIONS Thirty-seven percent of advanced cancer patients receiving PC inaccurately perceived their disease curable. These patients were more likely to have earlier PC referrals. An accurate perception of curability was associated with passive DCP. Further studies are needed to test effective communication strategies to mitigate this misperception.
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Affiliation(s)
- Sriram Yennurajalingam
- 1 Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center , Houston, Texas
| | - Zhanni Lu
- 1 Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center , Houston, Texas
| | - Bernard Prado
- 2 Department of Oncology and Hematology, Hospital Israelita Albert Einstein , Sao Paulo, Brazil
| | - Janet L Williams
- 1 Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center , Houston, Texas
| | - Kyu-Hyoung Lim
- 1 Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center , Houston, Texas
| | - Eduardo Bruera
- 1 Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center , Houston, Texas
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Padgett LS, Asher A, Cheville A. The Intersection of Rehabilitation and Palliative Care: Patients With Advanced Cancer in the Inpatient Rehabilitation Setting. Rehabil Nurs 2018; 43:219-228. [DOI: 10.1097/rnj.0000000000000171] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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18
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Yennurajalingam S, Rodrigues LF, Shamieh O, Tricou C, Filbet M, Naing K, Ramaswamy A, Perez-Cruz PE, Bautista MJS, Bunge S, Muckaden MA, Sewram V, Fakrooden S, Noguera-Tejedor A, Rao SS, Liu D, Park M, Williams JL, Lu Z, Cantu H, Hui D, Reddy SK, Bruera E. Perception of Curability Among Advanced Cancer Patients: An International Collaborative Study. Oncologist 2017; 23:501-506. [PMID: 29158371 DOI: 10.1634/theoncologist.2017-0264] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 09/26/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There are limited data on illness understanding and perception of cure among advanced cancer patients around the world. The aim of the study was to determine the frequency and factors associated with inaccurate perception of curability among advanced cancer patients receiving palliative care across the globe. MATERIALS AND METHODS Secondary analysis of a study to understand the core concepts in end-of-life care among advanced cancer patients receiving palliative care from 11 countries across the world. Advanced cancer patients were surveyed using a Patient Illness Understanding survey and Control Preference Scale. Descriptive statistics and multicovariate logistic regression analysis were performed. RESULTS Fifty-five percent (763/1,390) of patients receiving palliative care inaccurately reported that their cancer is curable. The median age was 58, 55% were female, 59% were married or had a partner, 48% were Catholic, and 35% were college educated. Sixty-eight percent perceived that the goal of therapy was "to get rid of their cancer," and 47% perceived themselves as "seriously ill." Multicovariate logistic regression analysis shows that accurate perception of curability was associated with female gender (odds ratio [OR] 0.73, p = .027), higher education (OR 0.37, p < .0001), unemployment status (OR 0.69, p = .02), and being from France (OR 0.26, p < .0001) and South Africa (OR 0.52, p = .034); inaccurate perception of curability was associated with better Karnofsky performance status (OR 1.02 per point, p = .0005), and being from Philippines (OR 15.49, p < .0001), Jordan (OR 8.43, p < .0001), Brazil (OR 2.17, p = .0037), and India (OR 2.47, p = .039). CONCLUSION Inaccurate perception of curability in advanced cancer patients is 55% and significantly differs by gender, education, performance status, employment status, and country of origin. Further studies are needed to develop strategies to reduce this misperception of curability in advanced cancer patients. IMPLICATIONS FOR PRACTICE The findings of this study indicate that inaccurate perception of curability among advanced cancer patients is 55%. Inaccurate perception of curability significantly differs by gender, education, performance status, employment status, and country of origin. There is great need to facilitate improved patient-physician communication so as to improve health care outcomes and patient satisfaction.
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Affiliation(s)
- Sriram Yennurajalingam
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Barretos, Brazil
| | | | - Omar Shamieh
- Palliative Care Department, King Hussein Cancer Center, Amman, Jordan
| | - Colombe Tricou
- Centre de soins palliatifs entre Hospitalier de Lyon-Sud, Hospices Civils de Lyon, Lyon, France
| | - Marilène Filbet
- Centre de soins palliatifs entre Hospitalier de Lyon-Sud, Hospices Civils de Lyon, Lyon, France
| | | | | | - Pedro Emilio Perez-Cruz
- Department of Internal Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Sofia Bunge
- Programa Argentino De Medicina, Olavaria, Argentina
| | | | - Vikash Sewram
- Faculty of Medicine and Health Sciences, University of Stellenbosch, Capetown, South Africa
| | | | | | - Shobha S Rao
- Division of Geriatrics and Palliative Care LBJ Hospital, Houston, TX
| | - Diane Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Minjeong Park
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Barretos, Brazil
| | - Janet L Williams
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Barretos, Brazil
| | - Zhanni Lu
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Barretos, Brazil
| | - Hilda Cantu
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Barretos, Brazil
| | - David Hui
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Barretos, Brazil
| | - Suresh K Reddy
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Barretos, Brazil
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Barretos, Brazil
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Hsiu Chen C, Wen FH, Hou MM, Hsieh CH, Chou WC, Chen JS, Chang WC, Tang ST. Transitions in Prognostic Awareness Among Terminally Ill Cancer Patients in Their Last 6 Months of Life Examined by Multi-State Markov Modeling. Oncologist 2017; 22:1135-1142. [PMID: 28684551 DOI: 10.1634/theoncologist.2017-0068] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 06/02/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Developing accurate prognostic awareness, a cornerstone of preference-based end-of-life (EOL) care decision-making, is a dynamic process involving more prognostic-awareness states than knowing or not knowing. Understanding the transition probabilities and time spent in each prognostic-awareness state can help clinicians identify trigger points for facilitating transitions toward accurate prognostic awareness. We examined transition probabilities in distinct prognostic-awareness states between consecutive time points in 247 cancer patients' last 6 months and estimated the time spent in each state. METHODS Prognostic awareness was categorized into four states: (a) unknown and not wanting to know, state 1; (b) unknown but wanting to know, state 2; (c) inaccurate awareness, state 3; and (d) accurate awareness, state 4. Transitional probabilities were examined by multistate Markov modeling. RESULTS Initially, 59.5% of patients had accurate prognostic awareness, whereas the probabilities of being in states 1-3 were 8.1%, 17.4%, and 15.0%, respectively. Patients' prognostic awareness generally remained unchanged (probabilities of remaining in the same state: 45.5%-92.9%). If prognostic awareness changed, it tended to shift toward higher prognostic-awareness states (probabilities of shifting to state 4 were 23.2%-36.6% for patients initially in states 1-3, followed by probabilities of shifting to state 3 for those in states 1 and 2 [9.8%-10.1%]). Patients were estimated to spend 1.29, 0.42, 0.68, and 3.61 months in states 1-4, respectively, in their last 6 months. CONCLUSION Terminally ill cancer patients' prognostic awareness generally remained unchanged, with a tendency to become more aware of their prognosis. Health care professionals should facilitate patients' transitions toward accurate prognostic awareness in a timely manner to promote preference-based EOL decisions. IMPLICATIONS FOR PRACTICE Terminally ill Taiwanese cancer patients' prognostic awareness generally remained stable, with a tendency toward developing higher states of awareness. Health care professionals should appropriately assess patients' readiness for prognostic information and respect patients' reluctance to confront their poor prognosis if they are not ready to know, but sensitively coach them to cultivate their accurate prognostic awareness, provide desired and understandable prognostic information for those who are ready to know, and give direct and honest prognostic information to clarify any misunderstandings for those with inaccurate awareness, thus ensuring that they develop accurate and realistic prognostic knowledge in time to make end-of-life care decisions.
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Affiliation(s)
- Chen Hsiu Chen
- Department of Nursing, University of Kang Ning, Taipei and Graduate Institute of Clinical Medical Science, Chang Gung University, Tao-Yuan, Taiwan
| | - Fur-Hsing Wen
- Department of International Business, Soochow University, Taipei, Taiwan
| | - Ming-Mo Hou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, and School of Medicine, Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Chia-Hsun Hsieh
- Division of Hematology-Oncology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, and School of Medicine, Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Wen-Chi Chou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, and School of Medicine, Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Jen-Shi Chen
- Division of Hematology-Oncology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, and School of Medicine, Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Wen-Cheng Chang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, and School of Medicine, Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Siew Tzuh Tang
- Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, and Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou
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20
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Chen CH, Kuo SC, Tang ST. Current status of accurate prognostic awareness in advanced/terminally ill cancer patients: Systematic review and meta-regression analysis. Palliat Med 2017; 31:406-418. [PMID: 27492160 DOI: 10.1177/0269216316663976] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND No systematic meta-analysis is available on the prevalence of cancer patients' accurate prognostic awareness and differences in accurate prognostic awareness by publication year, region, assessment method, and service received. AIM To examine the prevalence of advanced/terminal cancer patients' accurate prognostic awareness and differences in accurate prognostic awareness by publication year, region, assessment method, and service received. DESIGN Systematic review and meta-analysis. METHODS MEDLINE, Embase, The Cochrane Library, CINAHL, and PsycINFO were systematically searched on accurate prognostic awareness in adult patients with advanced/terminal cancer (1990-2014). Pooled prevalences were calculated for accurate prognostic awareness by a random-effects model. Differences in weighted estimates of accurate prognostic awareness were compared by meta-regression. RESULTS In total, 34 articles were retrieved for systematic review and meta-analysis. At best, only about half of advanced/terminal cancer patients accurately understood their prognosis (49.1%; 95% confidence interval: 42.7%-55.5%; range: 5.4%-85.7%). Accurate prognostic awareness was independent of service received and publication year, but highest in Australia, followed by East Asia, North America, and southern Europe and the United Kingdom (67.7%, 60.7%, 52.8%, and 36.0%, respectively; p = 0.019). Accurate prognostic awareness was higher by clinician assessment than by patient report (63.2% vs 44.5%, p < 0.001). CONCLUSION Less than half of advanced/terminal cancer patients accurately understood their prognosis, with significant variations by region and assessment method. Healthcare professionals should thoroughly assess advanced/terminal cancer patients' preferences for prognostic information and engage them in prognostic discussion early in the cancer trajectory, thus facilitating their accurate prognostic awareness and the quality of end-of-life care decision-making.
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Affiliation(s)
- Chen Hsiu Chen
- 1 Department of Nursing, University of Kang Ning, Tainan, Taiwan.,2 Graduate Institute of Clinical Medical Science, Chang Gung University, Tao-Yuan, Taiwan
| | - Su Ching Kuo
- 2 Graduate Institute of Clinical Medical Science, Chang Gung University, Tao-Yuan, Taiwan.,3 Department of Nursing, Yuanpei University, Hsinchu, Taiwan
| | - Siew Tzuh Tang
- 4 School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.,5 Department of Nursing, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,6 Division of Hematology-Oncology, Chang Gung Memorial Hospital, Linkou, Tao-Yuan, Taiwan
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Kirby S, Barlow V, Saurman E, Lyle D, Passey M, Currow D. Are rural and remote patients, families and caregivers needs in life-limiting illness different from those of urban dwellers? A narrative synthesis of the evidence. Aust J Rural Health 2016; 24:289-299. [PMID: 27378123 DOI: 10.1111/ajr.12312] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2016] [Indexed: 11/29/2022] Open
Abstract
This review aimed to assess the evidence to answer the question whether palliative end-of-life care needs of patients and caregivers in rural and remote communities differs from those of urban dwellers. Peer-reviewed studies from 1996 to the present dealing with the experience of rural and remote patients and caregivers at the end-of-life compared with that of urban people were extracted for narrative synthesis. The eight studies included showed that palliative needs of rural and remote residents are related to context. Diagnosis and treatment are less well managed in rural areas. Rural differences include: people are more accepting of death and less likely to intervene to delay death; caregivers tend to be younger and include friends as well as family and local support networks are important. Rural and remote end-of-life needs are shaped by reduced access and availability of services which has a negative influence on outcomes. This is counterbalanced by an acceptance of death and local support networks. Well-designed longitudinal studies with samples comprised of rural and urban residents for comparison are required to monitor how end-of-life need might change with the approach of death. Clinicians, health services and policy makers need a better understanding of rural attitudes and of how rural community networks mobilise to support end-of-life care in their rural and remote communities.
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Affiliation(s)
- Sue Kirby
- Broken Hill University Department of Rural Health, University of Sydney, Broken Hill, New South Wales, Australia.
| | - Veronica Barlow
- Broken Hill University Department of Rural Health, University of Sydney, Broken Hill, New South Wales, Australia
| | - Emily Saurman
- Broken Hill University Department of Rural Health, University of Sydney, Broken Hill, New South Wales, Australia
| | - David Lyle
- Broken Hill University Department of Rural Health, University of Sydney, Broken Hill, New South Wales, Australia
| | - Megan Passey
- University Centre for Rural Health Lismore, University of Sydney, Lismore, New South Wales, Australia
| | - David Currow
- Flinders University, Adelaide, South Australia, Australia
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Soylu C, Babacan T, Sever AR, Altundag K. Patients' understanding of treatment goals and disease course and their relationship with optimism, hope, and quality of life: a preliminary study among advanced breast cancer outpatients before receiving palliative treatment. Support Care Cancer 2016; 24:3481-8. [PMID: 27003902 DOI: 10.1007/s00520-016-3182-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 03/14/2016] [Indexed: 01/24/2023]
Abstract
PURPOSE The aims of this study were to explore advanced breast cancer patients' knowledge of treatment intent and expectation of illness course and to evaluate their relationship with optimism, hope, and quality of life (QoL). METHODS Patients with advanced breast cancer (n = 55) who were treated in the ambulatory clinic of the University of Hacettepe were included in the study. They completed Life Orientation Scale, The Hope Scale, and the European Organization for Research and Treatment of Cancer Quality of Life questionnaires. The data regarding the knowledge of illness progression and the perceptions of therapy intent were assessed using self-administered open-ended questionnaires that were answered by the patients. RESULTS The data revealed that 58.2 % of the patients had an inaccurate perception of treatment intent, believing the aim of treatment was cure, whereas only 38.2 % of the patients had a realistic expectation that their disease may remain stable or may progress over a year. In addition, the awareness of disease progression and perception of goals of treatment was significantly related to hope and optimism scores but not to QoL. CONCLUSIONS A large proportion of patients diagnosed with advanced breast cancer believed that their treatment was "curative", and they would improve within a year. Findings of our study suggest that patients with inaccurate perception of treatment intent and unrealistic expectation of prognosis have higher hope and optimism scores than those who do not, but there were no significant differences in terms of global health status.
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Affiliation(s)
- Cem Soylu
- Department of Psychology, Beytepe Campus, Hacettepe University, 06800, Ankara, Turkey.
| | - Taner Babacan
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Ali R Sever
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Kadri Altundag
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
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Greer JA, Pirl WF, Jackson VA, Muzikansky A, Lennes IT, Gallagher ER, Prigerson HG, Temel JS. Perceptions of health status and survival in patients with metastatic lung cancer. J Pain Symptom Manage 2014; 48:548-57. [PMID: 24680623 DOI: 10.1016/j.jpainsymman.2013.10.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 10/09/2013] [Accepted: 10/30/2013] [Indexed: 10/25/2022]
Abstract
CONTEXT Cognitive awareness of having a terminal illness is associated with critical treatment decisions and outcomes. However, little is known about the course and correlates of such perceptions in patients with metastatic lung cancer. OBJECTIVES We explored changes in perceptions of health status over time in patients with metastatic non-small cell lung cancer (NSCLC) and whether awareness of having a terminal illness was associated with survival. METHODS For this secondary analysis of clinical trial data, we assessed perceptions of health status at baseline, 12, 18, and 24 weeks. At each time point, patients with metastatic NSCLC completed a measure of quality of life (Functional Assessment of Cancer Therapy-Trial Outcome Index) and also reported whether they were "relatively healthy," "seriously but not terminally ill," or "seriously and terminally ill." We reviewed patients' medical records to gather data on clinical characteristics. RESULTS At baseline, 49.3% reported being relatively healthy, whereas the remainder self-identified as seriously but not terminally ill (38.2%) or seriously and terminally ill (12.5%). Over multiple assessments, 24.8% reported having a terminal illness. Adjusting for known prognostic factors, patients' time-varying perceptions of health status remained a significant predictor of survival (hazards ratio = 1.50, 95% CI = 1.07-2.09, P = 0.019). CONCLUSION A minority of patients with metastatic NSCLC acknowledged being terminally ill. Those reporting that they were seriously and terminally ill had shorter survival compared with those who did not consider themselves terminally ill, even after adjusting for decline in physical and functional well-being.
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Affiliation(s)
- Joseph A Greer
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA.
| | - William F Pirl
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Vicki A Jackson
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Alona Muzikansky
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Inga T Lennes
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Emily R Gallagher
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | | | - Jennifer S Temel
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
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Fletcher K, Prigerson HG, Paulk E, Temel J, Finlay E, Marr L, McCorkle R, Rivera L, Munoz F, Maciejewski PK. Gender differences in the evolution of illness understanding among patients with advanced cancer. ACTA ACUST UNITED AC 2014; 11:126-32. [PMID: 24400392 DOI: 10.12788/j.suponc.0007] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Patient understanding of advanced metastatic disease is central to decisions about care near death. Prior studies have focused on gender differences in communication style rather than on illness understanding. OBJECTIVES : To evaluate gender differences in terminal illness acknowledgement (TIA), understanding that the disease is incurable and the advanced stage of the disease. To evaluate gender differences in patients' reports of discussions of life expectancy with oncology providers and its effect on differences in illness understanding. METHODS Coping with Cancer 2 patients (N = 68) were interviewed before and after a visit with their oncology providers to discuss scan results. RESULTS At the prescan interview, there were no statistically significant gender differences in patient measures of illness understanding. At the postscan interview, women were more likely than men to recognize that their illness was incurable (Adjusted Odds Ratio, [AOR] = 5.29; P = .038), know that their cancer was at an advanced stage (AOR = 6.38; P = .013), and report having had discussions of life expectancy with their oncologist (AOR = 4.77; P = .021). Controlling discussions of life expectancy, women were more likely than men to report that their cancer was at an advanced stage (AOR = 9.53; P = .050). Controlling for gender, discussions of life expectancy were associated with higher rates of TIA (AOR = 4.65; P = .036) and higher rates of understanding that the cancer was incurable (AOR = 4.09; P = .085). CONCLUSIONS Due largely to gender differences in communication, women over time have a better understanding of their illness than men. More frequent discussions of life expectancy should enhance illness understanding and reduce gender differences.
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Affiliation(s)
- Kalen Fletcher
- Center for Psychosocial Epidemiology and Outcomes Research, Boston, Massachusetts, USA
| | - Holly G Prigerson
- Center for Psychosocial Epidemiology and Outcomes Research, Boston, Massachusetts, USA
| | - Elizabeth Paulk
- University of Texas Southwestern Medical Center, Dallas, USA
| | | | - Esme Finlay
- Division of Geriatrics and Palliative Medicine, University of New Mexico, Albuquerque, USA
| | - Lisa Marr
- Division of Geriatrics and Palliative Medicine, University of New Mexico, Albuquerque, USA
| | - Ruth McCorkle
- Smilow Cancer Hospital at Yale-New Haven, Connecticut, USA
| | | | - Francisco Munoz
- Pomona Valley Hospital Medical Center, Pomona, California, USA
| | - Paul K Maciejewski
- Center for Psychosocial Epidemiology and Outcomes Research, Boston, Massachusetts, USA
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Kawaguchi T, Azuma K, Yamaguchi T, Soeda H, Sekine Y, Koinuma M, Takeuchi H, Akashi T, Unezaki S. Development and validation of the Japanese version of the Decisional Conflict Scale to investigate the value of pharmacists' information: a before and after study. BMC Med Inform Decis Mak 2013; 13:50. [PMID: 23594514 PMCID: PMC3637610 DOI: 10.1186/1472-6947-13-50] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 04/15/2013] [Indexed: 11/10/2022] Open
Abstract
Background The information provided in patient-centered care and shared decision-making influences patients’ concerns and adherence to treatment. In the decision-making process, patients experience decisional conflict. The Decisional Conflict Scale (DCS) is a 16-item, self-administered questionnaire consisting of 5 subscales developed to assess patients’ decisional conflict. This study aimed to develop the Japanese version of the DCS and to clarify the influence of the information provided by pharmacists’ on decisional conflict among patients with cancer. Methods We developed the Japanese version of the DCS by using the forward-backward translation method. One hundred patients who were recommended a new chemotherapy regimen were recruited. The psychometric properties of the Japanese DCS, including internal consistency, convergent validity, discriminant validity, and construct validity, were examined. We assessed the decisional conflict of patients before and after the pharmacists’ provision of information. Results Ninety-four patients, predominately female, with an average age of 58.1 years were sampled. The scores on the 5 subscales of the DCS showed high internal consistency (Cronbach’s alpha = 0.84–0.96). Multi-trait scaling analysis and cluster analysis showed strong validity. The mean total DCS score decreased significantly from 40.2 to 31.7 after patients received information from the pharmacists (p < 0.001, paired t-test). Scores on all 5 subscales, namely, uncertainty, informed, values clarity, support, and effective decision, also significantly improved (p < 0.001 for all categories, paired t-test). Conclusions The psychometric properties of the Japanese version of the DCS are considered appropriate for it to be administered to patients with cancer. Pharmacists’ provision of information was able to decrease decisional conflict among patients with cancer who were recommended a new chemotherapy regimen.
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Cripe LD, Rawl SM, Schmidt KK, Tong Y, Monahan PO, Rand KL. Discussions of life expectancy moderate relationships between prognosis and anxiety or depression in men with advanced cancer. J Palliat Med 2012; 15:99-105. [PMID: 22268405 DOI: 10.1089/jpm.2011.0249] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Oncologists avoid prognostic discussions due to concerns about increasing patients' anxiety or depression. We sought to determine if perceived prognosis or extent of prognostic discussions predicted anxiety or depression and whether prognostic discussions moderated the relationship between prognosis and anxiety or depression. METHODS Men with advanced cancer and their oncologists estimated the likelihood of survival at 6 months and reported extent of prognostic discussions. Anxiety and depression were measured by the Hospital Anxiety and Depression Scale (HADS). RESULTS Men who died within 6 months reported higher scores on depression but not anxiety. Men who estimated a lower (10%-75%) likelihood of surviving at least 6 months were more depressed and anxious than men who estimated a higher (>90%) likelihood of survival. A similar relationship was seen with oncologists' prognostications. Men who reported having had full prognostic discussions with their oncologist had less depression compared with men who reported having had brief or no discussions. Men for whom the oncologists reported a full discussion had greater anxiety. The relationships between patient-perceived prognosis and depression or anxiety were moderated by extent of prognostic discussions as reported by the patient or oncologist, respectively. CONCLUSION Full prognostic discussions are associated with less depression among men who perceive a poor prognosis. Anxiety is increased in men if the oncologists report a full discussion. Oncologists should engage in prognostic discussions but assess for increased anxiety to facilitate coping with advanced cancer.
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Affiliation(s)
- Larry D Cripe
- Indiana University Simon Cancer Center, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA.
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Factors affecting treatment choices in paediatric palliative care: Comparing parents and health professionals. Eur J Cancer 2011; 47:2182-7. [DOI: 10.1016/j.ejca.2011.04.038] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 04/05/2011] [Accepted: 04/28/2011] [Indexed: 11/24/2022]
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Schaepe KS. Bad news and first impressions: patient and family caregiver accounts of learning the cancer diagnosis. Soc Sci Med 2011; 73:912-21. [PMID: 21813220 PMCID: PMC3166451 DOI: 10.1016/j.socscimed.2011.06.038] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 06/19/2011] [Accepted: 06/23/2011] [Indexed: 01/14/2023]
Abstract
Studies in medical journals regarding the delivery of a cancer diagnosis typically focus on a single clinic episode where the definitive news is disclosed to the patient by the physician. Far less research characterizes the diagnosis in the way patients and their family members often describe it: as a longitudinal, multi-sited search process culminating in a news-telling and realization event. This article analyzes lay accounts of learning a cancer diagnosis drawing on ethnographic interviews among a purposive sample of 28 patients recently diagnosed with leukemia, myeloma, or lymphoma and 30 of their family caregivers. The participants, recruited at a large cancer center in the United States, were asked to describe "the day" they learned the diagnosis. Narrative analysis revealed that in almost every case, detailed descriptions of preliminary events - such as the pace and sequence of testing; smooth or disorganized transitions between care providers; and the timeliness or delays in diagnosis - were used to contextualize the actual episode of hearing the diagnosis and reacting to the news. This study finds that patients' and caregivers' experience of the medical system prior to hearing the news played an important role in the way the news was ultimately internalized. The findings also provide empirical support for integrating lay perspectives on the diagnostic experience into future cancer disclosure guidelines.
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Affiliation(s)
- Karen Sue Schaepe
- University of Wisconsin-Madison, Sociology, 1180 Observatory Drive, Madison, WI 53706, United States.
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Yoong J, Jefford M, Mileshkin L. Patients' understanding of clinical trials needs to be assessed in the context of understanding of overall goals of care. Support Care Cancer 2011; 19:1067-8. [PMID: 21637973 DOI: 10.1007/s00520-011-1201-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 05/24/2011] [Indexed: 11/24/2022]
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Temel JS, Greer JA, Admane S, Gallagher ER, Jackson VA, Lynch TJ, Lennes IT, Dahlin CM, Pirl WF. Longitudinal perceptions of prognosis and goals of therapy in patients with metastatic non-small-cell lung cancer: results of a randomized study of early palliative care. J Clin Oncol 2011; 29:2319-26. [PMID: 21555700 DOI: 10.1200/jco.2010.32.4459] [Citation(s) in RCA: 470] [Impact Index Per Article: 36.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Understanding of prognosis among terminally ill patients impacts medical decision making. The aims of this study were to explore perceptions of prognosis and goals of therapy in patients with metastatic non-small-cell lung cancer (NSCLC) and to examine the effect of early palliative care on these views over time. PATIENTS AND METHODS Patients with newly diagnosed metastatic NSCLC were randomly assigned to receive either early palliative care integrated with standard oncology care or standard oncology care alone. Participants completed baseline and longitudinal assessments of their perceptions of prognosis and the goals of cancer therapy over a 6-month period. RESULTS We enrolled 151 participants on the study. Despite having terminal cancer, one third of patients (46 of 145 patients) reported that their cancer was curable at baseline, and a majority (86 of 124 patients) endorsed getting rid of all of the cancer as a goal of therapy. Baseline perceptions of prognosis (ie, curability) and goals of therapy did not differ significantly between study arms. A greater percentage of patients assigned to early palliative care retained or developed an accurate assessment of their prognosis over time (82.5% v 59.6%; P = .02) compared with those receiving standard care. Patients receiving early palliative care who reported an accurate perception of their prognosis were less likely to receive intravenous chemotherapy near the end of life (9.4% v 50%; P = .02). CONCLUSION Many patients with newly diagnosed metastatic NSCLC hold inaccurate perceptions of their prognoses. Early palliative care significantly improves patient understanding of prognosis over time, which may impact decision making about care near the end of life.
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Affiliation(s)
- Jennifer S Temel
- Massachusetts GeneralHospital Cancer Center, 55 Fruit Street, Massachusetts General Hospital, Boston, MA 02114, USA.
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Bélanger E, Rodríguez C, Groleau D. Shared decision-making in palliative care: a systematic mixed studies review using narrative synthesis. Palliat Med 2011; 25:242-61. [PMID: 21273220 DOI: 10.1177/0269216310389348] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study is to synthesize knowledge about the process of shared decision-making (SDM) in palliative care. Medline, EMBASE, CINAHL, PsychInfo, Web of Science were searched with core concepts: shared decisions, patient participation in decision-making, and palliative care. Titles and abstracts were screened according to inclusion criteria (original research, adult patients, Western contexts, decision-making, palliative treatment or setting), yielding 37 articles for analysis. A narrative synthesis was created using the methods of thematic analysis, conceptual mapping, and critical reflection on the synthesis process. Results demonstrate that while a majority of patients want to participate in treatment decisions to some extent, most do not achieve their preferred levels of involvement because decisions are delayed and alternative treatment options are seldom discussed. The literature regarding the process of SDM itself remains scarce in palliative care. Further research is needed in order to better understand the longitudinal, interactive, and interdisciplinary process of decision-making in palliative care.
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Affiliation(s)
- Emmanuelle Bélanger
- Division of Social and Transcultural Psychiatry, McGill University, Montreal, Canada.
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Attitudes towards palliative care in primary metastatic cancer: a survey among oncologists. Wien Klin Wochenschr 2010; 122:45-9. [PMID: 20177859 DOI: 10.1007/s00508-009-1295-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Accepted: 11/11/2009] [Indexed: 10/19/2022]
Abstract
Oncologists differ widely in their attitudes towards palliative care and services. These attitudes depend on a number of individual and society-based variables. It is recommended that palliative care be started early in the disease trajectory of patients with a life-threatening disease but in Austria we lack data on oncologists' adherence to this recommendation. We surveyed 785 oncologists in Austria by presenting the clinical course of a hypothetical patient with primary metastatic breast cancer from diagnosis until death. The majority of oncologists would involve palliative care services when the patient's Karnofsky index (KI) was < 50, and hospice services when the KI was < 40. Special training in palliative care was significantly associated with early use of hospice services. Reasons for not involving palliative care and hospice services earlier than indicated were systematically evaluated and included, among others, "fear of destroying the patient's hopes" (36% of respondents with regard to palliative services, 57% with regard to hospices). Overall, 67% of the oncologists would inform the patient about the malignant nature of her disease and the anticipated limitation of her life expectancy at the time of diagnosis. Issuing an advance directive would be discussed by only 25% at that time. Our data show that oncologists involve palliative care services at an advanced stage of disease in patients with primary metastatic cancer and that information about malignancy and the incurable nature of the disease is not uniformly provided at the time of diagnosis.
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Abstract
OBJECTIVE The aim of this research project was to gain an understanding of the experiences of rural cancer patients who commute to an urban cancer center for palliative care. METHOD The study utilized a mixed method design. Fifteen individuals with a palliative designation participated in semi-structured interviews and filled out the Problems and Needs in Palliative Care Questionnaire. RESULTS Qualitative findings included three major themes: cultures of rural life and care, strategies for commuting, and the effects of commuting. Participants valued their rural lifestyles and gained significant support from their communities. Strategies included preparing for the trip with particular attention to pain management, making the most of time, and maintaining significant relationships. Establishing a routine helped to offset the anxiety of commuting. Commuting was costly but the quality of life and supportive relationships obtained through treatment were significant benefits. Questionnaire data suggested that participants were experiencing a number of problems but few indicated they desired more professional attention to those problems. SIGNIFICANCE OF RESULTS Rural lifestyles are often an important part of overall well-being and commuting for care is both costly and complex. Health care providers should assist individuals to weigh the relative contributions of staying in their rural locale versus commuting for care to their overall quality of life. Palliative-care individuals in this study indicated a number of ongoing problems but were not inclined to seek further assistance from health care providers in addressing those problems. Clinicians should actively inquire about problems and further research is needed to understand why patients are reluctant to seek help.
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Wagner GJ, Riopelle D, Steckart J, Lorenz KA, Rosenfeld KE. Provider communication and patient understanding of life-limiting illness and their relationship to patient communication of treatment preferences. J Pain Symptom Manage 2010; 39:527-34. [PMID: 20171827 DOI: 10.1016/j.jpainsymman.2009.07.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Revised: 07/30/2009] [Accepted: 08/03/2009] [Indexed: 10/19/2022]
Abstract
Medical decision making in the context of serious illness ideally involves a patient who understands his or her condition and prognosis and can effectively formulate and communicate his or her care preferences. To understand the relationships among these care processes, we analyzed baseline interview data from veterans enrolled in a randomized controlled trial of a palliative care intervention. Participants were 400 inpatient veterans admitted with a physician-estimated risk of one-year mortality more than 25%; 260 (65%) had cancer as the primary diagnosis. Patients who believed that they had a life-limiting illness (89% of sample) reported that their provider had communicated this to them more frequently than those who did not share that belief (78% vs. 22%, P<0.001). Over half (53%) of the participants reported discussing their care preferences with their providers and 66% reported such discussions with their family; 35% had a living will. In multivariate analysis, greater functional impairment was associated with patients having discussed their care preferences with providers (P<0.05), whereas patient understanding of prognosis (P<0.05), better quality of life (P<0.01), and not being African American (P<0.05) were associated with patients having discussed their care preferences with family; higher education (P<0.001), and not being African American (P<0.01) were associated with having a living will. Patients with poor understanding of prognosis are less likely to discuss care preferences with family members, suggesting the importance of provider communication with patients regarding prognosis. Because functional decline may prompt physicians to discuss prognosis with patients, patients with relatively preserved function may particularly need such communication.
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McCullough L, McKinlay E, Barthow C, Moss C, Wise D. A model of treatment decision making when patients have advanced cancer: how do cancer treatment doctors and nurses contribute to the process? Eur J Cancer Care (Engl) 2009; 19:482-91. [PMID: 19912302 DOI: 10.1111/j.1365-2354.2009.01074.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This qualitative study describes how doctors and nurses report their contribution to treatment decision-making processes when patients have advanced cancer. Thirteen nurses and eight doctors involved in cancer treatment and palliation in one geographical location in New Zealand participated in the study. Data were collected using qualitative in-depth, face-to-face interviews. Content analysis revealed a complex context of decision making influenced by doctors and nurses as well as the patient and other factors. A model of clinician and patient decision making emerged with a distinct and cyclical process as advanced cancer remits and progresses. When patients have advanced cancer, nurses and doctors describe a predictable model of decision making in which they both contribute and that cycles through short- and long-term remissions; often nowadays to the point of the patient dying. In conclusion, the findings suggest doctors and nurses have different but complementary roles in what, when and how treatment choices are negotiated with patients, nevertheless within a distinct model of decision making.
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Affiliation(s)
- L McCullough
- Wellington Hospital, Capital and Coast District Health Board, Wellington South, Wellington, New Zealand.
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Letrilliart L, Milliat-Guittard L, Romestaing P, Schott AM, Berthoux N, Colin C. Building a shared patient record for breast cancer management: a French Delphi study. Eur J Cancer Care (Engl) 2009; 18:131-9. [PMID: 19267728 DOI: 10.1111/j.1365-2354.2007.00887.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Before electronic records become operational, patient-held records provide an opportunity to improve communication between patients and healthcare professionals. Our aim was to design the appropriate organization, layout and content for such a shared record for breast cancer management, based on a consensus between the various stakeholders. We therefore conducted a Delphi study within a working group of 48 members, including patients, oncologists, general practitioners, nurses and other professionals. The procedure featured three rounds during which participants' judgements were collected via mailed questionnaires and quantitative and qualitative feedback was provided on a regular basis. These three rounds were followed by an evaluation phase. Forty members (83%) participated in the three rounds. According to the agreement reached, the shared record was expected to include a front summary card, four sections for groups of users authorized to write down or insert information in the record (patient, physicians, medical auxiliaries and other healthcare professionals), and one section for medical imaging files. In addition, the record was to include specific categories of information as subsections within each of the various user sections. The participant satisfaction rate was over 90% for all aspects of the procedure, with the exception of interaction within the working group (79%).
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Affiliation(s)
- L Letrilliart
- Department of Medical Information, Hospices Civils de Lyon, Lyon, France.
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Winkler EC, Reiter-Theil S, Lange-Rieß D, Schmahl-Menges N, Hiddemann W. Patient Involvement in Decisions to Limit Treatment: The Crucial Role of Agreement Between Physician and Patient. J Clin Oncol 2009; 27:2225-30. [PMID: 19307508 DOI: 10.1200/jco.2008.17.9515] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The aim of this study was to describe, first, the decision-making process concerning the limitation of life-prolonging treatment (DLT); second, the extent to which patients are actually involved in these decisions; and third, to detect medical and ethical factors that affect patient involvement. Patients and Methods This prospective qualitative study enrolled 76 patients with incurable cancer with whom the limitation of life-prolonging treatment was discussed. Embedded researchers on the wards recorded the patient's history, medical condition, type of treatment limitation discussed, patient wishes, decision-making capacity, and patient involvement using an in-depth documentation procedure. Results While the majority of patients were informed about their diagnosis, therapy, and course of disease (99%, 97%, 90%, respectively), only 47% were involved in DLT. Two thirds of the patients preferred palliative care, and one third wished to extend their lifetime. If patients preferred palliative care, they were more often in line with physicians' treatment goals than patients who were striving for longer survival (91.4% v 46.7%; P = .001). They also were involved significantly more often in DLT. Multivariate analysis showed that age, Karnofsky performance index or decision-making capacity had no impact on patient involvement. Conclusion Only half of the patients were involved in DLT. Surprisingly, the main predictor of patient involvement was not their medical condition, but agreement with physicians' palliative treatment goals. These results show that if physicians switch to comfort care in terminally ill patients and patients are not yet prepared to follow this line, treatment limitations are often decided without involving the patient.
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Affiliation(s)
- Eva C. Winkler
- From the Department of Internal Medicine III, University Hospital Grosshadern; Ludwig-Maximilians University, Munich; Landshut Medical Center, Landshut, Germany; and the Department of Medical and Health Ethics, Medical Faculty, University of Basel, Switzerland
| | - Stella Reiter-Theil
- From the Department of Internal Medicine III, University Hospital Grosshadern; Ludwig-Maximilians University, Munich; Landshut Medical Center, Landshut, Germany; and the Department of Medical and Health Ethics, Medical Faculty, University of Basel, Switzerland
| | - Dorothee Lange-Rieß
- From the Department of Internal Medicine III, University Hospital Grosshadern; Ludwig-Maximilians University, Munich; Landshut Medical Center, Landshut, Germany; and the Department of Medical and Health Ethics, Medical Faculty, University of Basel, Switzerland
| | - Nina Schmahl-Menges
- From the Department of Internal Medicine III, University Hospital Grosshadern; Ludwig-Maximilians University, Munich; Landshut Medical Center, Landshut, Germany; and the Department of Medical and Health Ethics, Medical Faculty, University of Basel, Switzerland
| | - Wolfgang Hiddemann
- From the Department of Internal Medicine III, University Hospital Grosshadern; Ludwig-Maximilians University, Munich; Landshut Medical Center, Landshut, Germany; and the Department of Medical and Health Ethics, Medical Faculty, University of Basel, Switzerland
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García-Martínez F, Aguilar J, Barranco E, Royo J. La Atención Primaria en los programas de cuidados paliativos. Análisis de una serie de 34 pacientes. Semergen 2009. [DOI: 10.1016/s1138-3593(09)70718-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Robinson CA, Pesut B, Bottorff JL, Mowry A, Broughton S, Fyles G. Rural Palliative Care: A Comprehensive Review. J Palliat Med 2009; 12:10.1089/jpm.2008.0228. [PMID: 19216703 DOI: 10.1089/jpm.2008.0228] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract Background: Access to integrated, palliative care regardless of location of residence is a palliative care standard yet we know such access is limited for those living in rural and remote settings. As a beginning step in the development of research aimed at informing policy and program development, a comprehensive review of the state of knowledge regarding palliative care in rural contexts is required. Purpose: To identify, evaluate and synthesize the published literature on rural palliative care. Design: Comprehensive review. Methods: Computer searches were conducted on PubBMed, ISI Web of Science, PsycInfo, CINAHL, and Ageline using the search terms palliative care, hospice, terminal care, end-of-life care, end-of-life, and rural or remote. Results: One hundred fifty-eight studies were retrieved. After screening using relevance and quality criteria, 79 studies were included in the review. Studies were grouped by subject matter into one of three categories: patient and caregiver perspectives; professional attitudes, knowledge and practice issues; and health care services. Conclusion: The body of research literature is small and eclectic, which means there is little strong evidence to inform palliative policy and service development in rural settings. Coordinated programs of research are clearly required to develop a body of knowledge that is adequate to support effective service and policy development.
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Affiliation(s)
- Carole A Robinson
- 1 Faculty of Health and Social Development, UBC Okanagan , Kelowna British Columbia., 2 School of Nursing, UBC Okanagan , Kelowna British Columbia., 3 Centre for Healthy Living and Chronic Disease Prevention, UBC Okanagan , Kelowna British Columbia., 4 Palliative Care Services, Peterborough Regional Health Centre , Peterborough, Ontario, Canada ., 5 BC Cancer Agency-Centre for the Southern Interior , Kelowna, British Columbia., 6 Pain & Symptom Management/Palliative Care Program, BC Cancer Agency-Centre for the Southern Interior , Kelowna, British Columbia
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Teixeira JJV, Lefèvre F. [The meaning of medical intervention and religious faith for the elderly cancer patient]. CIENCIA & SAUDE COLETIVA 2008; 13:1247-56. [PMID: 18813624 DOI: 10.1590/s1413-81232008000400021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2006] [Accepted: 07/10/2007] [Indexed: 11/21/2022] Open
Abstract
This study aimed at identifying the meaning medical intervention and religious faith have for the elderly patient with cancer. A descriptive and qualitative investigation was developed between January 9 and March 28, 2001 in the Hospital do Servidor Público Estadual--Francisco Morato de Oliveira/IAMSPE (Hospital for State Public Servants). The studied sample was not randomized and consisted of 20 elderly men and women with cancer. The data were collected in semi-structured interviews and organized and analyzed using the Collective Subject Discourse method, applying three methodological illustrations: the Central Idea, Key Expressions and the Collective Subject Discourse (CSD). The main central ideas of the discourse material were: 1. Nothing to complain about. I think it is very good and they are on the right track; 2. No. For now, I'm doing everything the doctors say; 3. I've already participated, but not currently; 4. I don't participate in religious activity; 5. Invigoration, hope and balance. Religious faith is everything! 6. It remains the same; however, it changed the way to be. The CSD shows that the adopted medical intervention gave the elderly renewed hope and that religious faith is a key instrument for facing the disease.
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Affiliation(s)
- Jorge Juarez Vieira Teixeira
- Centro de Ciências Médicas e Farmacêuticas, Universidade Estadual do Oeste do Paraná, JardimUniversitário, Cascavel, PR.
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Kaldjian LC, Curtis AE, Shinkunas LA, Cannon KT. Review Article: Goals of Care Toward the End of Life: A Structured Literature Review. Am J Hosp Palliat Care 2008; 25:501-11. [DOI: 10.1177/1049909108328256] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Goals of care are often mentioned as an important component of end-of-life discussions, but there are diverse assessments regarding the type and number of goals that should be considered. To address this lack of consensus, we searched MEDLINE (1967—2007) for relevant articles and identified the number, phrasing, and type of goals they addressed. An iterative process of categorization resulted in a list of 6 practical, comprehensive goals: (1) be cured, (2) live longer, (3) improve or maintain function/quality of life/ independence, (4) be comfortable, (5) achieve life goals, and (6) provide support for family/caregiver. These goals can be used to articulate goal-oriented frameworks to guide decision making toward the end of life and thereby harmonize patients' treatment choices with their values and medical conditions.
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Affiliation(s)
- Lauris C. Kaldjian
- Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Carver College of Medicine, Program in Bioethics and Humanities, University of Iowa Carver College of Medicine, Center for Research in the Implementation of Innovative Strategies in Practice, Iowa City VA Medical Center,
| | - Ann E. Curtis
- Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Carver College of Medicine, Center for Research in the Implementation of Innovative Strategies in Practice, Iowa City VA Medical Center
| | - Laura A. Shinkunas
- Program in Bioethics and Humanities, University of Iowa Carver College of Medicine
| | - Katrina T. Cannon
- Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Carver College of Medicine, Center for Research in the Implementation of Innovative Strategies in Practice, Iowa City VA Medical Center
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Burns CM, Broom DH, Smith WT, Dear K, Craft PS. Fluctuating awareness of treatment goals among patients and their caregivers: a longitudinal study of a dynamic process. Support Care Cancer 2006; 15:187-96. [PMID: 16953423 DOI: 10.1007/s00520-006-0116-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2006] [Accepted: 06/21/2006] [Indexed: 11/30/2022]
Abstract
BACKGROUND Because increasing numbers of people now survive for months or years with advanced cancer, communication between patients, service providers, and family caregivers often continues over long periods. Hence, understanding of the goals of medical treatment may develop and change as time elapses and disease progresses. This understanding is closely related to the "awareness of dying," which has been studied in both qualitative and quantitative research. However, when both a patient and family caregiver are involved, the question of "awareness" becomes more complex. A recent longitudinal study reported on patient and caregiver knowledge of treatment goals, but no comparison of such knowledge using matched interview schedules and paired data analysis has been provided. This report examines patterns of awareness and factors associated with these patterns. MATERIALS AND METHODS One hundred sixty-three patients with incurable cancer and their nominated principal family caregivers (136) were recruited from The Canberra Hospital Oncology Services. Participants' understanding of the treatment goals were measured by interview questions at weeks 1 and 12. RESULTS One-third of both patients and caregivers understood that the treatment goal was not curative; however, not all patient and caregiver pairs had the same understanding. In 15% of pairs, both patient and caregiver believed that the goal of treatment was curative, while another 13% said that they did not know the aim of the treatment. Thirty-nine percent of pairs registered incongruent responses in which only one member of the pair understood that the treatment was not intended to cure the disease. Over time, a few respondents changed their perception of the treatment goals toward accurate clarification. Bivariate analysis using an awareness variable, constructed for the purpose, showed that in 6 months before death, at least one person in 89% of pairs understood that the treatment was noncurative. Time-to-death, gender, and place of residence were also important predictors of knowledge. CONCLUSIONS Discrepancies between patients and their caregivers may complicate the delivery of effective care when patients are seriously ill. Misunderstanding or uncertainty about treatment goals will obstruct proper informed consent. Health professionals providing care for families dealing with advanced cancer must recognize that the discussion of treatment goals is a dynamic process, which may require them to extend their communication skills.
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Affiliation(s)
- Catherine M Burns
- School of Social Administration and Social Work, Flinders University, GPO Box 2100, Adelaide, 5001, South Australia.
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Pazos González MG, Carreira Vidal MJ, García Fernández J. Entrevista semi-estructurada para la evaluación de la conciencia de enfermedad oncológica E-CEO. Estudio de fiabilidad sobre una muestra de pacientes con enfermedad avanzada. PSICOONCOLOGIA 1970. [DOI: 10.5209/psic.63645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objetivo: La comunicación entre pacientes oncológicos y profesionales de la salud se considera uno de los aspectos más importantes del cuidado, especialmente en fases avanzadas de la enfermedad. La conciencia de enfermedad consistiría en un proceso dinámico y cambiante en el tiempo, influenciado por la cantidad y calidad de la información y el significado que cada sujeto le asigna. En el presente trabajo se describe el proceso de diseño, validación y cálculo de la fiabilidad de una entrevista semiestructurada (Entrevista sobre la Conciencia de Enfermedad Oncológica E-CEO). Este instrumento, escasamente invasivo y no revelador de información, permite situar a los sujetos a lo largo de un continuum en base a su percepción de severidad de la enfermedad. Método: En una primera fase se realizó una entrevista abierta sobre 15 pacientes y se elaboró un listado de expresiones clave, que fueron agrupadas en cinco categorías. En una segunda fase se aplicó un modelo de entrevista semiestructurada a 42 pacientes ingresados con diagnóstico de enfermedad oncológica avanzada (estadio clínico IV) en la Unidad de Hospitalización de Oncología del Hospital de A Coruña. Resultados: La fiabilidad obtenida entre diferentes observadores muestra que se trata de un instrumento de elevada calidad (Kappa=0,70). Los datos reflejan una discrepancia amplia entre el estado de salud de los pacientes y su propia consideración. Más del 50% consideraron su enfermedad “controlada”. Conclusiones: Se trata de un instrumento de sencilla aplicación que permitirá en futuras investigaciones profundizar en el estudio de los procesos de integración de información en este tipo de pacientes.
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Navarro Jiménez JM, Cruzado JA, Boya Cristia MJ. Información sobre la quimioterapia paliativa en pacientes con cáncer avanzado: una revisión. PSICOONCOLOGIA 1970. [DOI: 10.5209/psic.55809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introducción. La quimioterapia paliativa es el tratamiento específico de primera elección en la mayoría de los pacientes oncológicos con enfermedad avanzada y es esencial que los pacientes entiendan los objetivos del tratamiento y las expectativas se ajusten al proceso de la enfermedad. Objetivo: Hacer una revisión sistemática sobre las creencias y expectativas que tienen los pacientes que reciben quimioterapia paliativa. Método. Se realizaron búsquedas en PubMed desde el año 2000 hasta la actualidad. Artículos escritos en inglés y español. Un total de 20 artículos cumplieron los criterios de inclusión. Resultados: Alrededor de la mitad de los pacientes que reciben quimioterapia paliativa, tienen creencias erróneas sobre las expectativas y objetivos del tratamiento. Los pacientes que entienden los objetivos del tratamiento presentan menor probabilidad de recibir quimioterapia al final de la vida, menores síntomas de ansiedad y depresión, mayor sensación de control y deseo de cuidados paliativos que se asocian a mejor calidad de vida. Conclusión: un porcentaje significativo de pacientes oncológicos en fase avanzada, reciben quimioterapia paliativa sin conocer el objetivo del tratamiento con expectativas erróneas de curarse, lo que dificulta la participación en la toma de decisiones sobre su plan de cuidados.
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