Prognostic Awareness in Advanced Disease: A Review Update and Concept Analysis

Abstract

PurposeAlthough subjective knowledge about the prognosis of an advanced disease is extremely important for coping and treatment planning, the concept of prognostic awareness (PA) remains inconsistently defined. The aims of the scoping review were to synthesize a definition of PA from the most recent literature, describe preconditions, correlates and consequences, and suggest a conceptual model.MethodsBy using scoping review methodology, we searched the Web of Science and PubMed databases, and included publications, reviews, meta-analyses or guidelines on all physical diagnoses, as well as publications offering a conceptual or an operational definition of PA. The data were analyzed by means of content analysis techniques.ResultsOf the 24 included publications, 21 referred exclusively to cancer, one to patients with hip fractures and two to palliative care in general. The deduced definition of PA comprised the following facets: adequate estimation of chances for recovery, knowledge of limited time to live, adequate estimation of life expectancy, knowledge of therapy goals, and knowledge of the course of the disease. Further content analysis results were mapped graphically and in a detailed table.ConclusionThere appears to be a lack of theoretical embedding of PA that in turn influences the methods used for empirical investigation. Drawing on a clear conceptual definition, longitudinal or experimental studies would be desirable.

Prognostic awareness and its association with health outcomes in the last year of life

“…19 Eligible participants were recruited from outpatient medical oncology clinics in two major public Singaporean hospitals. The eligibility criteria included being: (1) ≥21 years old; (2) a Singaporean citizen/permanent resident; (3) cognitively able to provide informed consent (i.e., determined using medical records or an Abbreviated Mental Test 20 for participants ≥60 years old); (4) diagnosed with stage IV solid malignancy; (5) having an Eastern Cooperative Oncology Group performance score of ≥2. 21 The questionnaires were administered by trained interviewers in the participant's language of choice (English, Mandarin, and Malay).…”

“…The importance of PA has been highlighted in recent studies, with findings demonstrating associations between PA and informed decision‐making, 2 reduction in futile treatments, 3 and increased illness acceptance 4 . Despite these benefits to the patient, concerns regarding the potential negative psychological consequences following prognostic disclosure have been raised, 5 with research indicating that PA can be associated with worse patient outcomes, including anxiety, 6 depression, 7 and spiritual 8 well‐being. These results can be generally understood to be in line with the conceptual framework provided by the Prognostic Awareness Impact Scale (PAIS), which posits that prognostically aware patients, if they do not have appropriate adaptive mechanisms, can suffer negative psychological consequences 9 .…”

Implementation of a Palliative Care Program in a Rural Hospital

“…16 Together, these 2 factors provided the perfect environment for establishing a foundation for a robust palliative care program as unplanned hospitalizations and COVID-related complications afforded many opportunities for the evaluation of prognosis and goals of care. The APRN at VEDG viewed prognostic awareness, "a patient's capacity to understand his or her prognosis and the likely illness trajectory," 18 as a crucial first step in the quest to impact patient outcomes. 2,18,19 Although certainly there are many complexities in predicting prognosis in most chronic illnesses, hospitalization related to exacerbation of diseases is an important transition point.…”

“…The APRN at VEDG viewed prognostic awareness, "a patient's capacity to understand his or her prognosis and the likely illness trajectory," 18 as a crucial first step in the quest to impact patient outcomes. 2,18,19 Although certainly there are many complexities in predicting prognosis in most chronic illnesses, hospitalization related to exacerbation of diseases is an important transition point. 20 The palliative APRN role at VEDG was adaptable and defined itself within the context of the hospital community.…”

Psychological Dimensions of Palliative Care Consultation

“…A recent systematic review of the concept found that essential components include an accurate estimation of possible recovery or incurable nature, awareness of mortality, and understanding of the goals of treatment. 9 When patient prognostic awareness is rated by researchers as "more accurate, " patients are more likely to have reduced aggressiveness of care at the end of life and possibly increased depressive symptoms. [10][11][12] Other scholars have situated prognostic awareness within the construct of general health literacy, although there is likely an emotional and existential component to this aspect of self-knowledge that sets it apart.…”