In:
The Oncologist, Oxford University Press (OUP), Vol. 22, No. 9 ( 2017-09-01), p. 1135-1142
Abstract:
Developing accurate prognostic awareness, a cornerstone of preference-based end-of-life (EOL) care decision-making, is a dynamic process involving more prognostic-awareness states than knowing or not knowing. Understanding the transition probabilities and time spent in each prognostic-awareness state can help clinicians identify trigger points for facilitating transitions toward accurate prognostic awareness. We examined transition probabilities in distinct prognostic-awareness states between consecutive time points in 247 cancer patients’ last 6 months and estimated the time spent in each state. Methods Prognostic awareness was categorized into four states: (a) unknown and not wanting to know, state 1; (b) unknown but wanting to know, state 2; (c) inaccurate awareness, state 3; and (d) accurate awareness, state 4. Transitional probabilities were examined by multistate Markov modeling. Results Initially, 59.5% of patients had accurate prognostic awareness, whereas the probabilities of being in states 1–3 were 8.1%, 17.4%, and 15.0%, respectively. Patients’ prognostic awareness generally remained unchanged (probabilities of remaining in the same state: 45.5%–92.9%). If prognostic awareness changed, it tended to shift 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 those in states 1 and 2 [9.8%–10.1%]). Patients were estimated to spend 1.29, 0.42, 0.68, and 3.61 months in states 1–4, respectively, in their last 6 months. Conclusion Terminally ill cancer patients’ prognostic awareness generally remained unchanged, with a tendency to become more aware of their prognosis. Health care professionals should facilitate patients’ transitions toward accurate prognostic awareness in a timely manner to promote preference-based EOL decisions.
Type of Medium:
Online Resource
ISSN:
1083-7159
,
1549-490X
DOI:
10.1634/theoncologist.2017-0068
Language:
English
Publisher:
Oxford University Press (OUP)
Publication Date:
2017
detail.hit.zdb_id:
2023829-0
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