Prognostic Awareness Affects EOL Decisions, QOL for Cancer Patients

07/21/17

Terminally ill patients’ understanding of their prognosis within the last six months of their life often times remain unchanged, according to a recent study.

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An important component of end-of-life (EOL) care decision-making is cultivating an accurate and realistic prognostic awareness in the patients. Developing such awareness involves transitioning through more prognostic-awareness states than simply knowing or not knowing. Researching transition probabilities and time spent in various prognostic-awareness states can help clinicians identify optimal moments for intervention toward accurate prognostic awareness.

A group of Taiwanese researchers conducted a study to examine transition probabilities in distinct prognostic-awareness states for terminally ill patients with cancer nearing EOL. A total of 247 patients, each within their last six months of life, were sampled. Researchers examined transition probability for each patient between consecutive time points and estimated the time spent in each prognostic-awareness state: unknown and not wanting to know (1), unknown but wanting to know (2), inaccurate awareness (3), and accurate awareness (4).

Patients were interviewed every 2 weeks to determine their prognostic awareness. The study was published in The Oncologist (online July 6, 2017; doi:10.1634/theoncologist.2017-0068).

Results of the study showed that 59.5% of patients had an accurate prognostic awareness at baseline, whereas the probability of being in states 1-3 were 8.1%, 17.4%, and 15.0%, respectively. While patients’ prognostic awareness often remained unchanged (probability of remaining in the same state: 45.5%-92.9%), most reported changes tended toward higher prognostic-awareness states; probabilities of shifting to state 4 were 23.2%-36.6% for patients initially in states 1-3, followed by probabilities of shifting to state 3 for patients initially in states 1-2 were 9.8%-10.1%.

Within their last six months of life, patients were estimated to spend 1.29, 0.42, 0.68, and 3.61 months in prognostic-awareness states 1-4, respectively. At time of death, researchers reported that 81.8% of patients were accurately aware.

Authors of the study concluded that clinicians should help foster patient prognostic awareness earlier in the process for terminally ill patients with cancer to provide sufficient time to understand their prognoses clearly. “Such timely and sensitive interventions would ensure that patients make full use of prognostic information in making informed and value-consistent EOL-care decisions,” they wrote.—Zachary Bessette