Associations among awareness of prognosis, hopefulness, and coping in patients with advanced cancer participating in phase I clinical trials

Abstract

Among the ACP who provided responses, many reported an unrealistic view of their prognosis. Having a more accurate view of prognosis in the face of terminal illness was associated with reduced hopefulness, which may be related to a poorer sense of coping. Finally, the prognosis question utilized in the study was problematic, led to a fairly poor response rate, and may be indicative of the many difficulties present in attempting to accurately assess ACPs' perceptions of their prognosis. Other methods, such as in-depth qualitative methods, may lead to more productive inquiry into ACPs' awareness of their prognosis. Further research into the accurate assessment of awareness of prognosis is needed.

Communication Strategies and Cultural Issues in the Delivery of Bad News

“…44 Depressed patients, men, and those with less education are more likely to misunderstand their prognosis. [73][74][75] Patients who inappropriately believe in the curability of their cancer are more likely to choose alternative and aggressive treatments. 67,68,76 Of note, in such patients with advanced disease, there does not appear to be a survival difference in those who choose treatment directed toward cure compared with those that choose palliation only.…”

Effects of Perception of Prognosis on Existential Well-Being and Ego-Integrity Among Advanced Cancer Patients

“…10 In a similar study, only 33% of the sample admitted awareness of the high likelihood of death from cancer within 5 years, and only 16% admitted awareness of death within one year. 5 Thus, overwhelmingly, patients in both studies placed themselves into the most optimistic category provided by the instrument or interview. Moreover, several studies found that only one-third of the patients with advanced cancer recognized that their cancer is not curable even with treatment, whereas one third of patients perceived their cancer to be curable.…”

“…This over-optimistic bias in prognostication may, in part, explain why patients often appear to have unrealistic expectations of survival, [3][4][5] and hold a far more overestimation of prognosis than their oncologists. 6 For instance, studies revealed that 82% of stage 4 cancer patients perceive their prognosis as much better than their oncologists.…”

“…Moreover, several studies found that only one-third of the patients with advanced cancer recognized that their cancer is not curable even with treatment, whereas one third of patients perceived their cancer to be curable. [4][5][6][7]11 Since disclosure of terminal prognosis of cancer is a common norm in western countries, it can be assumed that it is not a matter of understanding the facts, but a matter of perception. Still, there are quite enough reports of significant numbers of cancer patients in western countries, who are unaware of their prognosis.…”

“…For example, preliminary evidence revealed that having a more realistic perception of one's prognosis in the face of terminal illness may be associated with reduced hopefulness and a poorer sense of coping. 5 Another study demonstrated that complete disclosure of prognosis has bad influence on the patient's psychological wellbeing, QoL and even survival rate.…”