Factors associated with distinct prognostic‐awareness‐transition patterns over cancer patients’ last 6 months of life

Abstract

Background Cancer patients may develop prognostic awareness (PA) heterogeneously, but predictors of PA‐transition patterns have never been studied. We aimed to identify transition patterns of PA and their associated factors during cancer patients’ last 6 months. Methods For this secondary‐analysis study, PA was assessed among 334 cancer patients when they were first diagnosed as terminally ill and monthly till they died. PA was categorized into four states: (a) unknown and not wanting to know; (b) unknown but wanting to know; (c) inaccurate awareness; and (d) accurate awareness. The first and last PA states estimated by hidden Markov modeling were examined to identify their change patterns. Factors associated with distinct PA‐transition patterns were determined by multinomial logistic regressions focused on modifiable time‐varying variables assessed in the wave before the last PA assessment to ensure a clear time sequence for associating with PA‐transition patterns. Results Four PA‐transition patterns were identified: maintaining accurate PA (56.3%), gaining accurate PA (20.4%), heterogeneous PA (7.8%), and still avoiding PA (15.6%). Reported physician‐prognostic disclosure increased the likelihood of belonging to the maintaining‐accurate‐PA group than to other groups. Greater symptom distress predisposed patients to be in the still‐avoiding‐PA than the heterogeneous PA group. Patients with higher functional dependence and more anxiety/depressive symptoms were more and less likely to be in the heterogeneous PA group and in the still‐avoiding‐PA group, respectively, than in the maintaining‐ and gaining‐accurate PA groups. Conclusions Cancer patients heterogeneously experienced PA‐transition patterns over their last 6 months. Physicians’ prognostic disclosure, and patients’ symptom distress, functional dependence, and anxiety/depressive symptoms, all modifiable by high‐quality end‐of‐life care, were associated with distinct PA‐transition patterns.

Associations of prognostic‐awareness‐transition patterns with emotional distress and quality of life during terminally ill cancer patients' last 6 months of life

“…In the current manuscript, we extended this line of research to further examine the associations of prognostic‐awareness‐transition patterns with emotional distress and QOL because psychosocial well‐being and QOL are of utmost importance to advanced cancer patients at EOL 5 . The prevalence of accurate prognostic awareness did not differ between the experimental and control arms at baseline or in the patients' last 60 days 17 ; therefore, prognostic awareness data from both arms were combined to identify three distinct prognostic‐awareness‐transition patterns in previous studies 14,15 …”

“…Detailed information on the demographics, clinical characteristics, and time‐varying covariates of each prognostic‐awareness‐transition group has been reported 14,15 and essential information is presented in Table A1. In brief, the sample was primarily male (70.1%), married (85.0%), and had mean age of 57.93 (standard deviation [SD] = 11.15).…”

“…A considerable number of patients were excluded from our analysis because of a lack of monthly data to construct their prognostic-awareness-transition patterns. 14,15 Thus, generalization of our results is limited to patients assessed only once or twice in the same month after…”

“…We previously identified three prognostic‐awareness‐transition patterns incorporating both prognostic awareness and patient preference for prognostic information as maintaining‐accurate‐, gaining‐accurate‐, and maintaining‐inaccurate/unknown prognostic awareness 14,15 . Subsequently, no study has ever explored the associations of different prognostic‐awareness‐transition patterns with depression, anxiety, and QOL.…”

“…We previously identified three prognostic-awareness-transition patterns incorporating both prognostic awareness and patient preference for prognostic information as maintaining-accurate-, gaining-accurate-, and maintaining-inaccurate/unknown prognostic awareness. 14,15 Subsequently, no study has ever explored the associations of different prognostic-awareness-transition patterns with depression, anxiety, and QOL. Therefore, this study aimed to investigate the never-before-examined associations of these three prognostic-awareness-transition patterns with depressive symptoms, anxiety symptoms, and QOL measured by final assessment and mean difference over cancer patients' last 6 months.…”