Current status of accurate prognostic awareness in advanced/terminally ill cancer patients: Systematic review and meta-regression analysis

Abstract

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.

Transitions in Prognostic Awareness Among Terminally Ill Cancer Patients in Their Last 6 Months of Life Examined by Multi-State Markov Modeling

“…The majority of our patients (59.5%) were accurately aware of their prognosis at baseline, with a prevalence higher than that (49.1%) synthesized in a previous meta‐analysis of advanced/terminally ill cancer patients . Our higher observed initial prevalence of accurate prognostic awareness may be primarily due to our participants being diagnosed with terminal illness rather than the mix of meta‐analysis study subjects with advanced and terminal illness . Terminally ill cancer patients are more likely than advanced cancer patients to accurately understand their prognosis because as death approaches, their physical condition deteriorates and their physicians tend to disclose prognosis to them .…”

“…Becoming accurately aware of one's poor prognosis is a dynamic process , but in a recent 34‐study systematic review of advanced/terminally ill cancer patients’ prognostic awareness , the majority of studies ( n = 22; 64.7%) used cross‐sectional surveys. Only a handful of longitudinal studies explored changes in patients’ prognostic awareness more than twice , with several methodological shortcomings.…”

Uncertain diagnosis and prognosis in advanced melanoma: a qualitative study of the experiences of bereaved carers in a time of immune and targeted therapies

“…The consequences of unclear communication for patients and carers are significant, and prioritizing discussion of the details of treatment over prognosis may lead to missed opportunities in eliciting and considering patients’ and carers’ knowledge about and preferences for care. Medical specialists must promptly and thoroughly assess patients’ and carers’ preferences for prognostic information as early in the cancer trajectory as possible, and tailor information to individual needs, improving accurate prognostic awareness, personalizing care and avoiding potentially futile aggressive curative or life‐sustaining treatments due to unrealistic expectations …”

Patient‐hematologist discordance in perceived chance of cure in hematologic malignancies: A multicenter study

“…The majority of this discordance is skewed toward optimism, whereby patients tend to have higher expectations for cure. Discordance may exist due to patient‐related (eg, beliefs, emotional distress, social support), physician‐related (eg, communication, reluctance in discussing prognosis), and societal factors . This discordance appears to have significant implications for care received, because patients who are more optimistic also are more likely to opt for aggressive care and are less likely to accept palliative and comfort‐oriented care .…”

“…Discordance may exist due to patient-related (eg, beliefs, emotional distress, social support), physician-related (eg, communication, reluctance Cancer March 15, 2020 in discussing prognosis), and societal factors. [6][7][8][9][10][11][12] This discordance appears to have significant implications for care received, because patients who are more optimistic also are more likely to opt for aggressive care 13 and are less likely to accept palliative and comfort-oriented care. [14][15][16] To the best of our knowledge, prognostic discordance has been relatively underexplored in patients with hematologic malignancies, with the sparse existing studies having small sample sizes, [2][3][4] being conducted at a single site, and being focused primarily on patients with acute myeloid leukemia and myelodysplastic syndromes, or those undergoing allogeneic HCT.…”