Oncologists' dispositional affect and likelihood of end-of-life discussions.

Abstract

9 Background: Oncologist-patient end-of-life (EOL) discussions are associated with less aggressive care at EOL. Prior research on EOL discussions has not explored the role of oncologists’ dispositional affect, trait patterns of emotional responses. Affect could possibly facilitate or hinder broaching difficult EOL topics. We examined associations between oncologists’ disposition for experiencing positive and negative affect and likelihood of EOL discussions reported by their patients with advanced cancers. Methods: 350 patients with incurable lung and GI cancers were enrolled in a randomized trial of early palliative care within 8 weeks of diagnosis. Oncologists providing care for participants completed a measure of dispositional affect, Positive and Negative Affect Schedule (PANAS). Positive and negative affect scales were analyzed dichotomously (above/below sample median). At 24 weeks in the trial, patients reported if they had ever discussed with their oncologist the care they would want to receive if they were dying (yes/no). Associations between oncologists’ affect and patient-reported EOL discussions were tested with multilevel models clustered by oncologist, adjusting for patient age, cancer type, and randomization. Results: At 24 weeks, 57/242 (23.6%) patients reported having had EOL discussions. The PANAS was completed by 17/19 (89%) oncologists with patients in the trial. Patients treated by oncologists with higher negative affect reported more EOL conversations, but this did not reach statistical significance: OR = 1.76 [.81, 3.83], p = .15. Patients treated by oncologists with higher positive affect also reported more EOL conversations, but this did not reach statistical significance: OR = 1.66 [.83, 3.35], p = .15. However, patients treated by oncologists with both higher positive and higher negative affect were over 3 times as likely to report having had EOL discussions: OR = 3.22 [1.02, 10.23], p = .046. Conclusions: Patients treated by oncologists with greater propensity to experience both positive and negative affect were more likely to report EOL discussions compared to those treated by oncologists who experience lower levels of affect. More research is needed to better understand these relationships.