An Individualized, Interactive Intervention Promotes Terminally Ill Cancer Patients' Prognostic Awareness and Reduces Cardiopulmonary Resuscitation Received in the Last Month of Life: Secondary Analysis of a Randomized Clinical Trial

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

doi:10.1016/j.jpainsymman.2019.01.002

Cited by 18 publications

(31 citation statements)

References 49 publications

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“…If, for example, certain athletes are deemed to have a profile that is related to being susceptible to doping or they have a favorable attitude toward doping, they could be exposed to an individualized education program, which reflects their scores on other elements of the SDCM-AA. Evidence from other domains, such as education and medicine, revealed that individualized interventions are superior to generic interventions (e.g., Qian et al, 2018;Chen et al, 2019;Partanen et al, 2019). Published interventions designed to reduce doping prevalence have not differentiated between individuals and thus considered individual athletes' existing knowledge, attitudes, or susceptibility.…”

Section: Discussionmentioning

confidence: 99%

The Susceptibles, Chancers, Pragmatists, and Fair Players: An Examination of the Sport Drug Control Model for Adolescent Athletes, Cluster Effects, and Norm Values Among Adolescent Athletes

et al. 2020

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Although there are few high-profile cases of adolescent athletes being caught doping, up to a third of young athletes may dope. In order to generate a more accurate understanding of why adolescent athletes dope, it is important to validate models that help to explain this behavior. The aims of this study were 3-fold: firstly, to test the Sport Drug Control Model for Adolescent Athletes (SDCM-AA); secondly, to generate athlete profiles that would help quantify the proportion of athletes who are at risk of doping; and thirdly, to create norm values for the Adolescent Sport Doping Inventory (ASDI), which would allow national doping organizations, sporting organizations, and clubs to benchmark the scores of their athletes for key psycho-social variables linked to doping. A total of 2208 adolescent athletes from the United Kingdom, Australia, Hong Kong, and the United States completed the ASDI. The data presented an appropriate fit to the SDCM-AA model, in which 54% of the variance in susceptibility to doping was explained in the model, and 44.8% of attitudes toward doping was accounted for. Four distinct clusters of athletes emerged: the Susceptibles (i.e., identified with the benefits of doping, were willing to cheat, and viewed little threat), the Chancers (i.e., identified with the benefits of doping, scored high on willingness to cheat, and were highly influenced by their reference group, but had an average score for threat, self-esteem, and legitimacy), the Pragmatists (i.e., did not engage with any aspects of doping, but were more susceptible than the fair players), and Fair Players (i.e., high levels of sportspersonship, unwilling to cheat, and viewed doping as a threat). The revised SDCM-AA appears a valid model that helps explain the factors associated with doping attitudes and doping susceptibility. Adolescent athletes can be classified into one of four clusters, in relation to doping. Their cluster group could influence the content of the anti-doping education they receive.

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Section: Discussionmentioning

confidence: 99%

The Susceptibles, Chancers, Pragmatists, and Fair Players: An Examination of the Sport Drug Control Model for Adolescent Athletes, Cluster Effects, and Norm Values Among Adolescent Athletes

et al. 2020

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“…Uncertainty about one’s terminal status may decrease as death becomes nearer, 54 although many patients’ PA is relatively stable. 18,24,30 We expect that even themes that were infrequently endorsed in this preliminary study are likely present in other samples, including patients who have not (yet) enrolled in hospice.…”

Section: Discussionmentioning

confidence: 89%

“…4 PA is necessary for informed decision making, and patients use their prognostic beliefs to make consequential decisions about end-of-life planning and care, including whether and when to pursue curative and/or palliative care. Palliative care—aimed at improving quality of life for people with serious illness and their families 5 -9 —is typically associated with positive outcomes, 10 -13 but less likely to be used by patients who lack PA. 14,15 Patients who lack PA have also demonstrated greater anxiety and depression symptoms, 16 lower DNR (do not resuscitate) order completion rates (when caregivers also lack awareness), 17 and are more likely to receive CPR (cardiopulmonary resuscitation) at end of life 18 (but see 19 -21 ).…”

Section: Introductionmentioning

confidence: 99%

Understanding Hospice Patients’ Beliefs About Their Life Expectancy: A Qualitative Interview Study

Taber

Stacey

Sheehan

2020

Am J Hosp Palliat Care

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Background: Patients with advanced disease often overestimate their life expectancy, which potentially impacts decision making. Objective: To examine the nature and source of hospice patients’ life expectancy estimates, about which little is known. Design: Using semi-structured interviews, patients were asked to estimate their life expectancy and elaborate on their response. Setting/Subjects: Participants were hospice patients ( n = 20, 55% male; 60% cancer). Measurement: We conducted thematic analysis using open and focused coding. Results: Many participants had difficulty answering the life expectancy question and expressed uncertainty about when they would die. One-third overestimated their length of life relative to actual survival. The most common source of patients’ prognostic beliefs was knowledge about their body, including physical symptoms and change over time. Half of patients reported that a provider had given them a prognostic estimate, and one-third agreed with, or gave estimates consistent with, the provider’s estimate. Some patients said providers do not know prognosis or that time of death was unknowable. Conclusions: Key findings were that 1) many hospice patients had difficulty estimating life expectancy, and 2) hospice patients’ life expectancy estimates were frequently based on their body and not on information from medical providers. These findings have implications for measuring prognostic awareness, as valid assessment is a necessary component of determining whether prognostic awareness is beneficial for patients. Future research should examine how life expectancy estimates are associated with well-being and whether results extend to larger samples of patients with advanced disease not in hospice.

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“…With n = 16 (66.7%) of entries ( Diamond et al, 2014 , 2017 ; El-Jawahri et al, 2014 , 2015 ; Tang et al, 2014 , 2016a,b , 2018 ; Shin et al, 2016 ; Chen et al,2017a,b , 2019 ; Kurita et al, 2018 ; Mack et al, 2018 ; Sato et al, 2018 ; Janssens et al, 2019 ), this was one of the most important components of PA. Often ( n = 11), patients with advanced disease were only considered to have accurate PA if they viewed their disease as incurable ( Diamond et al, 2014 , 2017 ; Tang et al, 2014 , 2016a,b , 2018 ; Chen et al,2017a,b , 2019 ; Sato et al, 2018 ; Janssens et al, 2019 ); other authors ( n = 4) asked patients to rate their chances of recovery in percent (0–100%; El-Jawahri et al, 2014 , 2015 ; Shin et al, 2016 ; Mack et al, 2018 ). All patients who stated 0–10% chances of recovery and/or whose view was concordant with their physician’s assessment were then classified as having adequate PA.…”

Section: Resultsmentioning

confidence: 99%

Prognostic Awareness in Advanced Disease: A Review Update and Concept Analysis

et al. 2021

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PurposeAlthough subjective knowledge about the prognosis of an advanced disease is extremely important for coping and treatment planning, the concept of prognostic awareness (PA) remains inconsistently defined. The aims of the scoping review were to synthesize a definition of PA from the most recent literature, describe preconditions, correlates and consequences, and suggest a conceptual model.MethodsBy using scoping review methodology, we searched the Web of Science and PubMed databases, and included publications, reviews, meta-analyses or guidelines on all physical diagnoses, as well as publications offering a conceptual or an operational definition of PA. The data were analyzed by means of content analysis techniques.ResultsOf the 24 included publications, 21 referred exclusively to cancer, one to patients with hip fractures and two to palliative care in general. The deduced definition of PA comprised the following facets: adequate estimation of chances for recovery, knowledge of limited time to live, adequate estimation of life expectancy, knowledge of therapy goals, and knowledge of the course of the disease. Further content analysis results were mapped graphically and in a detailed table.ConclusionThere appears to be a lack of theoretical embedding of PA that in turn influences the methods used for empirical investigation. Drawing on a clear conceptual definition, longitudinal or experimental studies would be desirable.

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An Individualized, Interactive Intervention Promotes Terminally Ill Cancer Patients' Prognostic Awareness and Reduces Cardiopulmonary Resuscitation Received in the Last Month of Life: Secondary Analysis of a Randomized Clinical Trial

Cited by 18 publications

References 49 publications

The Susceptibles, Chancers, Pragmatists, and Fair Players: An Examination of the Sport Drug Control Model for Adolescent Athletes, Cluster Effects, and Norm Values Among Adolescent Athletes

The Susceptibles, Chancers, Pragmatists, and Fair Players: An Examination of the Sport Drug Control Model for Adolescent Athletes, Cluster Effects, and Norm Values Among Adolescent Athletes

Understanding Hospice Patients’ Beliefs About Their Life Expectancy: A Qualitative Interview Study

Prognostic Awareness in Advanced Disease: A Review Update and Concept Analysis

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