Can Oncologists Prompt Patient Prognostic Awareness to Enhance Decision-Making? Data From the NEOetic Study

Author:

Carmona-Bayonas Alberto1ORCID,Rodriguez-Gonzalez Adán2ORCID,García-García Teresa3ORCID,Velasco-Durantez Verónica4ORCID,Hernández-San Gil Raquel5ORCID,Cruz-Castellanos Patricia6ORCID,Fernandez-Montes Ana7ORCID,Castillo-Trujillo Alfredo2ORCID,Ballester Inmaculada1ORCID,Rogado Jacobo8ORCID,Calderon Caterina9ORCID,Jimenez-Fonseca Paula2ORCID

Affiliation:

1. Department of Medical Oncology, Hospital Universitario Morales Meseguer, University of Murcia, UMU, IMIB , Murcia , Spain

2. Department of Medical Oncology, Hospital Universitario Central de Asturias, ISPA, Faculty of Medicine, University of Oviedo , Oviedo , Spain

3. Department of Medical Oncology, Hospital General Universitario Santa Lucia , Cartagena , Spain

4. Department of Medical Oncology, Hospital Universitario Central de Asturias, ISPA, Oviedo, Faculty of Medicine, University of Valladolid , Valladolid , Spain

5. Department of Medical Oncology, Hospital Universitario de Canarias , Tenerife , Spain

6. Department of Medical Oncology, Hospital General Universitario de Ciudad Real , Ciudad Real , Spain

7. Department of Medical Oncology, Complejo Hospitalario Universitario de Ourense , Orense , Spain

8. Department of Medical Oncology, Hospital Universitario Infanta Leonor , Madrid , Spain

9. Department of Clinical Psychology and Psychobiology, Faculty of Psychology. University of Barcelona , Spain

Abstract

Abstract Introduction Anti-neoplastic therapy improves the prognosis for advanced cancer, albeit it is not curative. An ethical dilemma that often arises during patients’ first appointment with the oncologist is to give them only the prognostic information they can tolerate, even at the cost of compromising preference-based decision-making, versus giving them full information to force prompt prognostic awareness, at the risk of causing psychological harm. Methods We recruited 550 participants with advanced cancer. After the appointment, patients and clinicians completed several questionnaires about preferences, expectations, prognostic awareness, hope, psychological symptoms, and other treatment-related aspects. The aim was to characterize the prevalence, explanatory factors, and consequences of inaccurate prognostic awareness and interest in therapy. Results Inaccurate prognostic awareness affected 74%, conditioned by the administration of vague information without alluding to death (odds ratio [OR] 2.54; 95% CI, 1.47-4.37, adjusted P = .006). A full 68% agreed to low-efficacy therapies. Ethical and psychological factors oriented first-line decision-making, in a trade-off in which some lose quality of life and mood, for others to gain autonomy. Imprecise prognostic awareness was associated with greater interest in low-efficacy treatments (OR 2.27; 95% CI, 1.31-3.84; adjusted P = .017), whereas realistic understanding increased anxiety (OR 1.63; 95% CI, 1.01-2.65; adjusted P = 0.038), depression (OR 1.96; 95% CI, 1.23-3.11; adjusted P = .020), and diminished quality of life (OR 0.47; 95% CI, 0.29-0.75; adjusted P = .011). Conclusion In the age of immunotherapy and targeted therapies, many appear not to understand that antineoplastic therapy is not curative. Within the mix of inputs that comprise inaccurate prognostic awareness, many psychosocial factors are as relevant as the physicians’ disclosure of information. Thus, the desire for better decision-making can actually harm the patient.

Funder

FSEOM

Publisher

Oxford University Press (OUP)

Subject

Cancer Research,Oncology

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