Abstract
Realistic illness understanding is essential to an advanced cancer patient's ability to make informed medical decisions at the end of life. This study sought to determine whether advanced cancer patients better understood the late stage of their cancer if an oncologist, compared to other members of the care team, was present to discuss their scan results. Data were derived from a multi‐institutional, longitudinal cohort study of patients recruited between 2010 and 2015. Patients (n = 209) with late‐stage cancers (metastatic cancers that progressed after at least one chemotherapy regimen) were interviewed before and after clinic visits in which scan results were discussed. Patients reported pre‐ and postvisit if their cancer was at a late stage. Postvisit, patients reported if they discussed scan results with an oncologist or another oncology provider (i.e., oncology fellow, oncology resident, nurse practitioner, nurse, physician's assistant, or other). Logistic regression analysis was used to determine if the presence of an oncologist during scan results discussions differentially predicted the patients' likelihood of postvisit late‐stage illness understanding (LSIU). Propensity weighting was used to correct for sociodemographic imbalances between groups, and previsit LSIU and the presence of multiple providers were controlled for in the logistic regression analyses. After propensity‐weighted adjustment and controlling for previsit LSIU and the presence of multiple providers, patients were 2.6 times more likely (AOR = 2.6; 95% CI = 1.2, 6.0; P = 0.021) to report that their disease was late stage if an oncologist was present for the scan results discussion compared to if an oncologist was absent. The presence of an oncologist during scan results discussions was associated with a higher likelihood of patients acknowledging being in a late stage of their disease. These results suggest that oncologist involvement in scan results discussions is associated with advanced cancer patients having better prognostic understanding.
Highlights
For patients to engage in informed end-of-life (EoL) decision-making, they must have a realistic understanding of their prognosis [1,2,3]
A total of 41.1% of patients acknowledged that their cancer was late stage during the previsit interview, and 47.8% of patients acknowledged that their cancer was late stage during the postvisit interview
209 patients in analytic sample previsit late-stage illness understanding (LSIU) and the presence of multiple providers. These results indicate that patients who discussed their recent scan results with an oncologist present versus an oncologist absent were more likely to understand the late stage of their illness after that discussion (AOR = 2.6; 95% CI = 1.2, 6.0; P = 0.021; power = 0.90)
Summary
For patients to engage in informed end-of-life (EoL) decision-making, they must have a realistic understanding of their prognosis [1,2,3]. Recent studies indicate that only 37.7% of patients a median of 4.4 months from death acknowledged that they were terminally ill [6] and only 5% reported completely accurate understanding of their prognosis (i.e., correct response to four measures of illness understanding) [7]. These findings highlight the need to improve illness understanding among advanced cancer patients
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