Conceptualizing prognostic awareness in advanced cancer: A systematic review

Abstract

This systematic review synthesizes the complex literature on prognostic awareness in cancer. A total of 37 studies examining cancer patients’ understanding of their prognosis were included. Prognostic awareness definitions and assessment methods were inconsistent across studies. A surprisingly high percentage of patients (up to 75%) were unaware of their poor prognosis, and in several studies, even their cancer diagnosis (up to 96%), particularly in studies conducted outside of North America. This review highlights surprisingly low rates of prognostic awareness in patients with advanced cancer as well as discrepancies in prognostic awareness assessment, suggesting the need for empirically validated measures of prognostic awareness.

Dimensionality, Stability, and Validity of the Beck Hopelessness Scale in Cancer Patients Receiving Curative and Palliative Treatment

“…As studies have demonstrated that a significant percentage of patients is not or only partly aware of the cancer prognosis and treatment intention, this might have decreased our ability to detect differences between patients receiving curative and palliative treatment. 39 …”

Daily Life Experiences of Patients With a High-Grade Glioma and Their Caregivers

“…A significant correlation between accurate PI and reduced psychological distress in patients with advanced cancer has been identified (Chochinov, Tataryn, Wilson, Ennis, & Lander, 2000;Innes & Payne, 2009;Thompson et al, 2009) and is in line with our findings indicating that preferences for PI can act as a catalyst, promoting the individual's adjustment to the HGG diagnosis. PI may facilitate end-of-life planning (Applebaum et al, 2014), but there is a risk of causing increased distress instead. PI needs to be based on a strategy that accounts for individual preferences and approaches to managing a life crisis (Lobb et al, 2011).…”

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

“…Yet, in many cultures, such as in collectivist Asian and Muslim cultures, illness is a shared family affair, and concealing the truth is a common practice, whereas in Western cultures, the disclosure of diagnosis and terminal prognosis is regarded as patient autonomy [8]. Relating to these issues, the prognostic awareness of patients with cancer has generated a growing interest among researchers [9][10][11][12][13]. However, the prevalence of disease prognosis and perception of treatment purpose were inconsistent in these studies.…”

“…However, a different study that was conducted among 163 patients with advanced cancer who were receiving palliative therapies revealed that only 30.4 % of patients believed that the aim of their treatment was curative [17]. In a systemic review that was recently conducted by Applebaum et al [12] that analyzed 37 studies examining cancer patients' understanding of their prognosis indicated that up to 75 % of advanced cancer patients were unaware of their poor prognosis.…”