Perceptions of medical status and treatment goal among older adults with advanced cancer

Association of Prognostic Understanding With Health Care Use Among Older Adults With Advanced Cancer

“…Among older patients with advanced gastrointestinal cancers, those who had poor prognostic understanding (ie, those who selected non–terminally ill status) had a lower risk of hospitalization. 15 Although not statistically significant (because the 95% CI crosses 1), our results also suggested that patients with poor understanding regarding life expectancy estimates may be less likely to be hospitalized. These patients perceived themselves as likely to live longer, and their positive perceptions may have been because of a better underlying health status, which might confer a lower risk of hospitalization.…”

“… 8 , 13 Despite these findings, to our knowledge, few studies have focused on prognostic understanding among older adults and prognostic discordance between older adults and clinicians. 8 , 14 , 15 , 16 Furthermore, the association between poor prognostic understanding or prognostic discordance and health care use among older adults with advanced incurable cancers is not well characterized. 15 Studies have shown that disagreements between patient and physician in various aspects of care can be associated with negative outcomes, such as diminished trust in the physician, dissatisfaction with the visit, lack of adherence to treatment, higher rates of hospitalization, and increased risk of death.…”

“…8,[14][15][16] Furthermore, the association between poor prognostic understanding or prognostic discordance and health care use among older adults with advanced incurable cancers is not well characterized. 15 Studies have shown that disagreements between patient and physician in various aspects of care can be associated with negative outcomes, such as diminished trust in the physician, dissatisfaction with the visit, lack of adherence to treatment, higher rates of hospitalization, and increased risk of death. [17][18][19][20] In this study, we focused on prognostic understanding in older adults with advanced cancer.…”

“…There are also oncologist-related factors associated with prognostic communication and understanding (eg, lack of confidence in responding to patients’ emotions during prognostic discussion and overestimation of prognosis) . Despite these findings, to our knowledge, few studies have focused on prognostic understanding among older adults and prognostic discordance between older adults and clinicians . Furthermore, the association between poor prognostic understanding or prognostic discordance and health care use among older adults with advanced incurable cancers is not well characterized .…”

Effects of an Oncology Nurse-Led, Primary Palliative Care Intervention (CONNECT) on Illness Expectations Among Patients With Advanced Cancer

“…3,4 Unrealistic illness expectations may be problematic because patients make different medical decisions on the basis of their expectations of prognosis, treatment aims, and illness trajectory. 3,[5][6][7][8] More realistic patient illness expectations are associated with transitions in medical care that better reflect patient preferences, earlier hospice referral, and decreased health care resource utilization near the end of life. 1,4,5,7,[9][10][11] Specialty palliative care promotes discussions about patient prognostic awareness, goals, and future planning and has been associated with improved patient coping abilities and communication regarding end-of-life preferences when provided alongside standard oncology care for patients with advanced cancer.…”