Doctors’ Prognostic Accuracy in Terminally Ill Patients (DRAFT)

2018 ◽  
Author(s):  
Anjali Desai ◽  
Andrew S. Epstein
Keyword(s):  
Patient Care ◽  
Cancer Patients ◽  
Clinical Case ◽  
Terminally Ill ◽  
Terminally Ill Cancer Patients ◽  
Factors Associated ◽  
Terminally Ill Patients ◽  
Prognostic Accuracy ◽  
Study Results ◽  
Practical Implications

“Doctors’ Prognostic Accuracy in Terminally Ill Patients” reviews one of Christakis and Lamont’s landmark articles, which investigated the factors associated with prognostic accuracy (and prognostic error) in doctors’ prognoses for terminally ill patients. The article explored the extent and determinants of optimistic errors, pessimistic errors, and correct predictions among doctors who were estimating prognoses for their terminally ill patients. This chapter offers a concise breakdown of the study’s design and salient study results while also pointing out study limitations. The chapter summarizes other relevant studies exploring prognostic estimates and prognostic disclosure by physicians to terminally ill cancer patients. Finally, the chapter provides a clinical case to illustrate some of the study’s practical implications for patient care.

scholarly journals What Are Terminally Ill Cancer Patients Told About Their Expected Deaths? A Study of Cancer Physicians’ Self-Reports of Prognosis Disclosure

2008 ◽  
Vol 26 (36) ◽  
pp. 5988-5993 ◽  
Author(s):  
Christopher K. Daugherty ◽  
Fay J. Hlubocky
Keyword(s):  
Cancer Patients ◽  
Cancer Care ◽  
Terminally Ill ◽  
The United States ◽  
Prognostic Information ◽  
Usual Practice ◽  
Terminally Ill Cancer Patients ◽  
Terminally Ill Patients ◽  
Medical Oncologists ◽  
Self Reports

Purpose Little is known about how physicians discuss prognosis with terminally ill cancer patients. Thus, we sought to obtain cancer physicians’ self-reports of their prognosis communication practices. Methods A survey seeking self-reports regarding prognosis communication with their terminally ill cancer patients was mailed to a systematic sample of medical oncologists in the United States. Results Of 1,137 physicians, 729 completed and returned surveys (64% response rate). Median age of respondents was 51 years (range, 33 to 80 years); 82% were men. Respondents had practiced cancer care for a median of 18 years (range, 1.5 to 50 years) and reported seeing a median of 60 patients per week (range, 0 to 250 patients per week). Although 98% said their usual practice is to tell terminally ill patients that they will die, 48% specifically described communicating terminal prognoses to patients only when specific preferences for prognosis information were expressed. Forty-three percent said they always or usually communicate a medical estimate of time as to when death is likely to occur, and 57% reported sometimes, rarely, or never giving a time frame. Seventy-three percent said prognosis communication education was either absent or inadequate during their training, and 96% believed it should be part of cancer care training. Conclusion Medical oncologists report routinely informing their terminally ill patients that they will die. However, they are divided in describing themselves as either always discussing a terminal prognosis or doing so if it is consistent with their patients’ preferences for prognostic information. Most medical oncologists say they do not routinely communicate an estimated survival time to their patients.

The Family in Hospital-Based Home Care with Special Reference to Terminally Ill Cancer Patients

1993 ◽  
Vol 9 (1) ◽  
pp. 5-13 ◽  
Author(s):  
Barbro Beck-Friis ◽  
Peter Strang
Keyword(s):  
Home Care ◽  
Cancer Patients ◽  
Symptom Control ◽  
Terminally Ill ◽  
Next Of Kin ◽  
Terminally Ill Cancer Patients ◽  
Terminally Ill Patients ◽  
Economic Support ◽  
The Family

Eighty-seven next of kin, 80 spouses and seven adult children, were the primary caregivers of terminally ill patients (87% cancer patients) cared for at the hospital-based home care (HBHC) unit of Motala Hospital during 1989–1990. All of the patients died in their homes. Next of kin were asked to complete self-questionnaires and to give written comments on their experiences and their perception of how the patient had felt about 13 aspects of home care provided by the HBHC staff. The response rate was 94%. In nine out of 13 areas, such as adequate information at the time of referral about the HBHC, security, support, immediate extra help when needed, high quality of nursing, and care and pain control, 86%–97% of next of kin were very satisfied (7–9 on a 9-point scale); whereas information provided about the disease, economic support, and support given after death were very satisfactory according to 72%, 58%, and 80% of relatives, respectively. Gender and time from diagnosis to death did not seem to affect responses. Next of kin of cancer patients were generally more satisfied than next of kin of other terminally ill patients. A total time of care of more than 60 days (median time) was associated with significantly more positive responses. Older spouses were significantly more satisfied with the HBHC than younger ones; despite this, 99% of all next of kin would choose HBHC again in a similar situation. It is concluded that very satisfactory terminal home care can be achieved, but it presupposes effective, prompt support and symptom control, 24 hours per day, and that both patient and family wish to participate in the HBHC.

Existential Issues in Palliative Care — Interviews with Cancer Patients

2000 ◽  
Vol 16 (2) ◽  
pp. 20-24 ◽  
Author(s):  
Ingrid Bolmsjö
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Terminally Ill ◽  
Terminally Ill Cancer Patients ◽  
Terminally Ill Patients ◽  
Existential Distress ◽  
Patients Experience ◽  
Existential Issues

A minority of terminally ill patients achieve a peaceful death. Many factors, including existential distress, contribute to the emotional disquiet of patients. This study focuses on the reactions of terminally ill cancer patients to questions concerning existential issues within the themes of meaning, relations, autonomy, guilt, dignity, and communication. The results of this study indicate that patients experience a number of problems dealing with existential issues, consider these questions important, and wish to be able to discuss these types of questions with someone.

Factors associated with difficulties encountered by nurses in the care of terminally ill cancer patients in hospitals in Japan

2005 ◽  
Vol 3 (1) ◽  
pp. 15-22 ◽  
Author(s):  
TOMOYO SASAHARA ◽  
MITSUNORI MIYASHITA ◽  
MASAKO KAWA ◽  
KEIKO KAZUMA
Keyword(s):  
End Of Life ◽  
Cancer Patients ◽  
Multivariate Regression ◽  
Terminally Ill ◽  
Multivariate Regression Analysis ◽  
Terminally Ill Cancer Patients ◽  
Factors Associated ◽  
Life Issues ◽  
End Of Life Issues ◽  
General Wards

Objective:To identify the factors associated with difficulties encountered by nurses working in general wards in hospitals in Japan.Methods:Questionnaires including items regarding difficulties in providing care to terminally ill cancer patients, the existence of a mentor regarding end-of-life issues, awareness of end-of-life issues, and demographic factors were administered to 375 staff nurses working in general in-patient wards. Multivariate regression analyses were employed to investigate correlations between factors.Results:Multivariate regression analysis revealed that the existence of a mentor for end-of-life issues was associated with fewer difficulties in all areas other than “Knowledge and skill of nurses.” Clinical experience was inversely related to difficulties in “Communication with patients and families” and “Personal issues.” Greater awareness of end-of-life issues was related to higher difficulties in most areas.Significance of results:The existence of a mentor was correlated with fewer difficulties in most areas. Support by a palliative care team might be effective in reducing difficulties experienced by nurses and in improving care for terminally ill cancer patients. Basic communication training undertaken sooner after registration might be also useful.

scholarly journals Factors Associated with Care Burden among Family Caregivers of Terminally Ill Cancer Patients

2016 ◽  
Vol 19 (1) ◽  
pp. 61-69 ◽  
Author(s):  
Jee Hye Lee ◽  
Hyun Kyung Park ◽  
In Cheol Hwang ◽  
Hyo Min Kim ◽  
Su-Jin Koh ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Family Caregivers ◽  
Terminally Ill ◽  
Care Burden ◽  
Terminally Ill Cancer Patients ◽  
Factors Associated

Factors associated with quality of life among family caregivers of terminally ill cancer patients

2015 ◽  
Vol 25 (2) ◽  
pp. 217-224 ◽  
Author(s):  
Youn Seon Choi ◽  
Sun Wook Hwang ◽  
In Cheol Hwang ◽  
Yong Ju Lee ◽  
Young Sung Kim ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cancer Patients ◽  
Family Caregivers ◽  
Terminally Ill ◽  
Terminally Ill Cancer Patients ◽  
Factors Associated

Which terminally ill cancer patients receive hospice in-patient care?

1998 ◽  
Vol 46 (8) ◽  
pp. 1011-1016 ◽  
Author(s):  
Julia Addington-Hall ◽  
Dan Altmann ◽  
Mark McCarthy
Keyword(s):  
Patient Care ◽  
Cancer Patients ◽  
Terminally Ill ◽  
Terminally Ill Cancer Patients

Seasonal mortality in terminally ill cancer patients

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 6575-6575
Author(s):  
J. Policzer ◽  
B. Kinzbrunner ◽  
D. Tanis
Keyword(s):  
Seasonal Variation ◽  
Cancer Patients ◽  
Terminally Ill ◽  
Strong Support ◽  
Term Care ◽  
Ample Evidence ◽  
Seasonal Mortality ◽  
Terminally Ill Cancer Patients ◽  
Terminally Ill Patients ◽  
Frail Patients

6575 Background: There is ample evidence that the death rate in elderly patients increases in winter months. The increase in deaths may be amplified in terminally ill patients where place of care home, hospital, or long-term care facility might play a significant role in seasonal mortality. In this paper, we compare seasonal variation in death rates for terminally ill cancer patients to terminally ill patients who are “frail,” i.e., those with neurodegenerative disease, general debility, or chronic heart failure. Methods: We reviewed monthly deaths for Medicare patients age 65 or older with terminal cancer or “frail” patients who were admitted to one of 45 hospice programs and died on service between January 2004 and November 2008. The 72,066 records were analyzed using a three-way analysis of variance (season, place of care, diagnosis) with Bonferroni correction for post-hoc comparisons. Results: Compared to frail patients who died during June, July, and August, the number of deaths of frail patients increased an average of 20% in January, February, and March. This near-sinusoidal pattern was remarkably consistent over a five year period. The effect was most pronounced in patients in nursing facilities, followed by those in hospital, and then by patients receiving home care (all p < 0.005). For cancer patients, this seasonal variation was not observed in any place of care (all p > 0.05). Conclusions: Although frail patients generally have a longer length of stay in hospice than cancer patients hence allowing more opportunity for exposure to infection a number of other factors may serve to insulate cancer patients from seasonal effects. These include a smaller “symptom burden” than frail patients, who frequently have comorbid disease(s) and who are often unable to make their needs known; less compromised immune systems; more aggressive medical treatment; better nutrition; a strong support system (particularly from family and caregivers); and increased sensitivity to factors that may prolong survival, e.g., timely immunizations and even the avoidance of crowds in winter months. No significant financial relationships to disclose.

Predictive Factors for the Development of Dyspnea Within 7 Days After Admission Among Terminally Ill Cancer Patients

2021 ◽  
pp. 104990912110288
Author(s):  
Ryo Matsunuma ◽  
Takashi Yamaguchi ◽  
Masanori Mori ◽  
Tomoo Ikari ◽  
Kozue Suzuki ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Predictive Factors ◽  
Performance Status ◽  
Univariate Analysis ◽  
Terminally Ill ◽  
Primary Lung Cancer ◽  
Poor Performance Status ◽  
Terminally Ill Cancer Patients ◽  
Development Group

Background: Predictive factors for the development of dyspnea have not been reported among terminally ill cancer patients. Objective: This current study aimed to identify the predictive factors attributed to the development of dyspnea within 7 days after admission among patients with cancer. Methods: This was a secondary analysis of a multicenter prospective observational study on the dying process among patients admitted in inpatient hospices/palliative care units. Patients were divided into 2 groups: those who developed dyspnea (development group) and those who did not (non-development group). To determine independent predictive factors, univariate and multivariate analyses using the logistic regression model were performed. Results: From January 2017 to December 2017, 1159 patients were included in this analysis. Univariate analysis showed that male participants, those with primary lung cancer, ascites, and Karnofsky Performance Status score (KPS) of ≤40, smokers, and benzodiazepine users were significantly higher in the development group. Multivariate analysis revealed that primary lung cancer (odds ratio [OR]: 2.80, 95% confidence interval [95% CI]: 1.47-5.31; p = 0.002), KPS score (≤40) (OR: 1.84, 95% CI: 1.02-3.31; p = 0.044), and presence of ascites (OR: 2.34, 95% CI: 1.36-4.02; p = 0.002) were independent predictive factors for the development of dyspnea. Conclusions: Lung cancer, poor performance status, and ascites may be predictive factors for the development of dyspnea among terminally ill cancer patients. However, further studies should be performed to validate these findings.

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