Political economy of hope as a cultural facet of biomedicalization: A qualitative examination of constraints to hospice utilization among U.S. end-stage cancer patients

Mrig, Emily Hammad; Spencer, Karen Lutfey

doi:10.1016/j.socscimed.2018.01.033

Cited by 24 publications

(19 citation statements)

References 36 publications

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“…45 Messages regarding the benefits of hope and a positive attitude often are embedded within cancer care. 45 Messages regarding the benefits of hope and a positive attitude often are embedded within cancer care.…”

Section: Discussionmentioning

confidence: 99%

“…45 Messages regarding the benefits of hope and a positive attitude often are embedded within cancer care. 45,46 Furthermore, hospice enrollment may be considered synonymous with "giving up," thereby reducing patient and caregiver willingness to pursue hospice. 37 These messages may interfere with patients' and caregivers' willingness to discuss poor prognosis and enroll in hospice.…”

Section: Discussionmentioning

confidence: 99%

“…The relationship between prognostic understanding and hospice enrollment noted in the current study also may be attributable to a desire to maintain hope and a positive perspective. 45 Messages regarding the benefits of hope and a positive attitude often are embedded within cancer care. Moreover, the scientific literature regarding the health benefits of a positive perspective generates considerable media attention.…”

Section: Discussionmentioning

confidence: 99%

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Association between advanced cancer patient‐caregiver agreement regarding prognosis and hospice enrollment

Trevino

Prigerson

Shen

et al. 2019

Cancer

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BACKGROUND: Patients with advanced, incurable cancer who understand their illness is incurable are more likely to prefer hospice care at the end of life compared with patients who believe their illness is curable. To the authors' knowledge, it is unclear whether patient-caregiver agreement regarding perceived prognosis is associated with hospice enrollment. METHODS: The current study examined the prospective relationship between patient-caregiver agreement concerning perceived prognosis and hospice enrollment in the last 30 days of life. Data were collected during a cluster randomized controlled trial examining a communication intervention for oncologists and patients with advanced cancer and their caregivers. At the time of study entry, patients and caregivers (141 dyads) were categorized as endorsing a "good" prognosis if they: 1) reported a >50% chance of surviving ≥2 years; or if they 2) predicted that the patient's quality of life 3 months into the future would be ≥7 on an 11-point scale. RESULTS: Approximately one-fifth of dyads agreed on a poor prognosis whereas approximately one-half disagreed regarding prognosis. In approximately one-third of dyads, patients and caregivers both believed the patient's future quality of life would be good (34%) and that the patient would live for ≥2 years (30%). Patients in these dyads were less likely to enroll in hospice compared with patients in dyads who disagreed and those who agreed on a shorter life expectancy and poor future quality of life. CONCLUSIONS: Dyadic understanding of patients' projected life expectancy and future quality of life appears to be predictive of care received at the end of life. Improving rates of hospice enrollment may be best achieved with dyadic interventions. Cancer 2019;125:3259-3265.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Association between advanced cancer patient‐caregiver agreement regarding prognosis and hospice enrollment

Trevino

Prigerson

Shen

et al. 2019

Cancer

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“…Although some patients experience positive responses to new therapies, medical specialists, including dermatologists, oncologists and surgeons, are confronted with complex discussions around prognosis and the role of palliative and end‐of‐life care . Indeed, although aggressive interventions may be promising, large numbers of patients receiving palliative radiation or chemotherapy hold unrealistic hopes of cure through such interventions, which is likely to impact their ability to make well‐informed decisions about treatment options and end‐of‐life care . Patients are often exposed to aggressive care and treatments near the end of life, raising concerns for the quality of care received and degree to which patient goals of care were discussed and addressed .…”

mentioning

confidence: 99%

“…Patients are often exposed to aggressive care and treatments near the end of life, raising concerns for the quality of care received and degree to which patient goals of care were discussed and addressed . Significantly, the interface between oncology and palliative care services is an ongoing challenge as emerging treatments reshape expectations and norms in end‐of‐life decision making, where stakes are high …”

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confidence: 99%

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

et al. 2019

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Summary Background Recent advances in advanced melanoma therapies are associated with improved survival for some patients. However, how patients with diagnoses of advanced disease and their carers experience this expanding treatment paradigm is not well understood. Objectives To explore bereaved carers’ accounts of the trajectory of advanced melanoma involving treatment by immune or targeted therapies, to build an understanding of their experiences of care relating to diagnosis and prognosis. Methods A qualitative exploratory design, using methods drawn from grounded theory, was adopted. Analyses drew on in‐depth interviews with 20 bereaved carers from three metropolitan melanoma treatment centres in Australia. A flexible interview guide and structured approach to concurrent data collection and analysis were applied. Results Carers described qualities of the experience, including the shock of diagnosis after a sometimes‐innocuous presentation with vague symptoms. They reported an unclear prognosis with complexity arising from interplay between an uncertain disease trajectory and often ambiguous expectations of outcomes of emerging immune and targeted therapies. Uncertainty dominated carers’ experiences, increasing the complexity of care planning. Conclusions Effective communication of an advanced melanoma diagnosis and prognosis is critical. Recognition of the uncertainty inherent in the benefit of immune and targeted therapies in a constructive manner may facilitate more timely and effective care‐planning conversations between patients, carers and medical specialists.

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Mental Health Care for Gastrointestinal Cancer Patients. II-2-2. Hospice Care

Chun

Park

Lim

et al. 2023

Gastrointestinal Cancer

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Political economy of hope as a cultural facet of biomedicalization: A qualitative examination of constraints to hospice utilization among U.S. end-stage cancer patients

Cited by 24 publications

References 36 publications

Association between advanced cancer patient‐caregiver agreement regarding prognosis and hospice enrollment

Association between advanced cancer patient‐caregiver agreement regarding prognosis and hospice enrollment

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

Mental Health Care for Gastrointestinal Cancer Patients. II-2-2. Hospice Care

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