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It's not what you think: Associations between perceived cognitive and physical status and prognostic understanding in patients with advanced cancer.

It's not what you think: Associations between perceived cognitive and physical status and prognostic understanding in patients with advanced cancer.

Title
Publication TypeJournal Article
Year of Publication2018
AuthorsKurita K, Siegler EL, M Reid C, Maciejewski RC, Prigerson HG
JournalJ Pain Symptom Manage
Date Published2018 May 09
ISSN1873-6513
Abstract

CONTEXT: Patients with advanced cancer often overestimate their time left to live. Those who have heightened awareness of their cognitive and physical deficits at the end of life may have a better prognostic understanding.

OBJECTIVES: We sought to investigate the extent to which patients' self-reports of physical well-being and cognitive function were associated with prognostic understanding.

METHODS: Logistic regression analyzed data from Coping with Cancer II, a National Cancer Institute-funded study of patients with advanced cancer from nine US cancer clinics. Patients with metastatic cancers who had an oncologist-estimated life-expectancy of less than 6 months and did not have significant cognitive impairment were eligible (N= 300). Trained interviewers administered subsets of the McGill Quality of Life and the Functional Assessment of Cancer Therapy - Cognition Version 2 to measure physical well-being and cognitive complaints. There were 4 dichotomous outcomes: acknowledgment of their terminal illness; understanding that their diagnosis was late- or end-stage; belief that life-expectancy was months, not years; and prognostic understanding, which was defined as accurate responses to all three questions. Covariates included age and gender.

RESULTS: Worse patient-reported physical well-being and cognitive function were independently associated with the patient's acknowledgment of his/her terminal illness (AOR = 0.91, 95% CI = 0.82 to 1.00, p = 0.047; AOR = 1.73, 95% CI = 1.17 to 2.55, p = 0.006, respectively).

CONCLUSION: Patients who reported worse cognitive function and physical well-being were more aware of their terminal illness than those with better cognitive function.

DOI10.1016/j.jpainsymman.2018.04.016
Alternate JournalJ Pain Symptom Manage
PubMed ID29753102
Grant ListT32 AG049666 / AG / NIA NIH HHS / United States
R35 CA197730 / CA / NCI NIH HHS / United States
R01 MD007652 / MD / NIMHD NIH HHS / United States
R01 CA106370 / CA / NCI NIH HHS / United States
R01 CA168387 / CA / NCI NIH HHS / United States
R01 MH063892 / MH / NIMH NIH HHS / United States
R21 CA218313 / CA / NCI NIH HHS / United States

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