TY - JOUR
T1 - Advanced Cancer Patients' Changes in Accurate Prognostic Understanding and Their Psychological Well-Being
AU - George, Login S.
AU - Maciejewski, Paul K.
AU - Epstein, Andrew S.
AU - Shen, Megan
AU - Prigerson, Holly G.
N1 - Funding Information: Dr. George reports grants from the National Cancer Institute during the conduct of the study; Dr. Epstein reports royalties from Up-To-Date for peer reviewing gastrointestinal medical oncology and palliative care topic reviews; Dr. Prigerson reports grants from National Cancer Institute during the conduct of the study; Drs. Prigerson and Epstein and Maciejewski are supported by National Institute of Nursing Research ( NR018693 ); Dr. Maciejewski has nothing to disclose; and Dr. Shen has nothing to disclose. Funding is supported by the National Cancer Institute ( CA106370 , CA197730 , P30 CA008748 , and T32 CA009461) . Publisher Copyright: © 2020 American Academy of Hospice and Palliative Medicine
PY - 2020/5
Y1 - 2020/5
N2 - Context: Clinicians often worry that patients' recognition of the terminal nature of their illness may impair psychological well-being. Objectives: To determine if such recognition was associated with decrements to psychological well-being that persisted over time. Methods: About 87 patients with advanced cancer, with an oncologist-expected life expectancy of less than six months, were assessed before and after an oncology visit to discuss cancer restaging scan results and again at follow-up (median time between assessments, approximately six weeks). Prognostic understanding (PU) was assessed at previsit and postvisit, and a change score was computed. Psychological well-being was assessed at pre, post, and follow-up, and two change scores were computed (post minus pre; follow-up minus post). Results: Changes toward more accurate PU was associated with a corresponding initial decline in psychological well-being (r = −0.33; P < 0.01) but thereafter was associated with subsequent improvements (r = 0.40; P < 0.001). This pattern remained controlling for potential confounds. Patients showed different patterns of psychological well-being change (F = 3.07, P = 0.05; F = 6.54, P < 0.01): among patients with improved PU accuracy, well-being initially decreased but subsequently recovered; by contrast, among patients with stable PU accuracy, well-being remained relatively unchanged, and among patients with decrements in PU accuracy, well-being initially improved but subsequently declined. Conclusion: Improved PU may be associated with initial decrements in psychological well-being, followed by patients rebounding to baseline levels. Concerns about lasting psychological harm may not need to be a deterrent to having prognostic discussions with patients.
AB - Context: Clinicians often worry that patients' recognition of the terminal nature of their illness may impair psychological well-being. Objectives: To determine if such recognition was associated with decrements to psychological well-being that persisted over time. Methods: About 87 patients with advanced cancer, with an oncologist-expected life expectancy of less than six months, were assessed before and after an oncology visit to discuss cancer restaging scan results and again at follow-up (median time between assessments, approximately six weeks). Prognostic understanding (PU) was assessed at previsit and postvisit, and a change score was computed. Psychological well-being was assessed at pre, post, and follow-up, and two change scores were computed (post minus pre; follow-up minus post). Results: Changes toward more accurate PU was associated with a corresponding initial decline in psychological well-being (r = −0.33; P < 0.01) but thereafter was associated with subsequent improvements (r = 0.40; P < 0.001). This pattern remained controlling for potential confounds. Patients showed different patterns of psychological well-being change (F = 3.07, P = 0.05; F = 6.54, P < 0.01): among patients with improved PU accuracy, well-being initially decreased but subsequently recovered; by contrast, among patients with stable PU accuracy, well-being remained relatively unchanged, and among patients with decrements in PU accuracy, well-being initially improved but subsequently declined. Conclusion: Improved PU may be associated with initial decrements in psychological well-being, followed by patients rebounding to baseline levels. Concerns about lasting psychological harm may not need to be a deterrent to having prognostic discussions with patients.
KW - Prognosis
KW - adaptation
KW - comprehension
KW - life expectancy
KW - longitudinal studies
KW - psychological
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U2 - https://doi.org/10.1016/j.jpainsymman.2019.12.366
DO - https://doi.org/10.1016/j.jpainsymman.2019.12.366
M3 - Article
C2 - 31887399
VL - 59
SP - 983
EP - 989
JO - Journal of Pain and Symptom Management
JF - Journal of Pain and Symptom Management
SN - 0885-3924
IS - 5
ER -