Perceiving hope from oncologists and prognostic understanding and treatment planning.

Abstract

21 Background: Offering hope during prognostic discussions is widely considered essential to the delivery of humane medical care. However, clinicians always offering hope may undermine realism in patients' prognostic understanding and preparation for what lies ahead. We examine how patients’ perceptions of their oncologists as always offering hope, compared to a more tempered sense of hope, relate to prognostic understanding and treatment planning. Methods: Data came from post-scan baseline assessments of an NCI funded multi-site study on prognostic communication among metastatic cancer patients’ refractory to at least one chemotherapy regimen. The analytic sample consisted of 235 participants, who during structured interviews, rated the question, “how often does your oncologist offer hope,” as “always,” “most of the time” or “sometimes.” A binary variable was created comparing participants endorsing “always” to participants endorsing “most of the time” or “sometimes.” Patients also reported on elements of prognostic understanding, DNR order completion, and preference for either life-extending or comfort care. Results: Patients who rated their oncologists as “always” offering hope (62.1%), compared to those who rated “most of the time” or “sometimes” (37.9%), were more likely to have inaccurate prognostic understanding regarding life-expectancy ( OR = 0.40; 95% CI, 0.16, 0.97), and marginally more likely to have a treatment preference that favored life-extending care over comfort care ( OR = 0.61; 95% CI, 0.35, 1.07). A significant moderation effect was seen ( b = -1.43, p = .04) such that accurate understanding of the incurability of their cancer was associated with DNR completion only among patients who perceived more tempered hope from oncologists ( OR = 5.53; 95% CI, 1.80, 17.02), and not among patients who always perceived hope ( OR = 1.32; 95% CI, 0.63, 2.78). Conclusions: Results suggest that the tempering of hope may have benefits, as perceiving oncologists as always offering hope was associated with worse prognostic understanding and lower advance care planning. Future research examining in a more nuanced way the nature of hope offered (e.g., hope for cure vs. symptom management) in longitudinal designs is needed.