“Months, not years”: Impact of clinical discussions of advanced cancer life-expectancy on patient illness understanding.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 30-30
Author(s):  
Andrew S. Epstein ◽  
Holly Gwen Prigerson ◽  
Leonard Saltz ◽  
Eileen Mary O'Reilly ◽  
Manish A. Shah ◽  
...  
Keyword(s):  
Life Expectancy ◽  
End Of Life ◽  
Advanced Cancer ◽  
Best Practice ◽  
Chemotherapy Regimen ◽  
Advanced Cancer Patients ◽  
Coping With Cancer ◽  
Before And After ◽  
Observational Cohort ◽  
Upper Gastrointestinal

30 Background: Patients’ understanding of their illness often guides best practice, and this is no less true at the end of life. Data showing the influence of patients’ acknowledgment of prognostic discussions on the accuracy of patients’ illness understanding could inform the debate regarding how to engage in these difficult discussions. Methods: To evaluate the effects of recent and past oncologist-patient discussions about prognosis/life-expectancy (P/LE) on changes in advanced cancer patents’ illness understanding (acknowledgement of their illness as 1. terminal; 2. incurable; 3. advance staged; and 4. associated with an estimated life-expectancy in months, not years), 208 patients (with advanced lung or upper gastrointestinal cancers that progressed on 1 chemotherapy regimen, or advanced colorectal cancers that progressed on 2) from Coping with Cancer II, a prospective observational cohort study, were interviewed before and after a visit with their oncologists who discussed scan results regarding potential additional progression. Results: Median time between pre- and post-scan interviews was 38 days. Controlling for potential confounds (i.e., patients’ race) and adjusting for patients’ pre-scan illness understanding, patients who acknowledged ever having discussions of P/LE with their oncologists were more likely to recognize that their disease was incurable (Adjusted Odds Ratio [AOR] = 2.97, p = 0.009) than those who did not. Compared to patients who denied ever having a discussion of P/LE, those who reported having both recent and past discussions of P/LE were more likely to recognize that their disease was at an advanced stage (AOR = 4.88, p = 0.012), and those who reported having only recent discussions, or both recent and past discussions, of P/LE were more likely to estimate their life-expectancy in terms of months as opposed to years (AOR = 10.1, p = 0.050, and AOR = 17.5, p = 0.006, respectively). Conclusions: Advanced cancer patients who acknowledge having discussions of P/LE with their oncologists have a better understanding of the terminal nature of their illnesses as compared to those who do not, and thus may be better prepared to make informed end-of-life care decisions.

Tailoring end-of-life discussions to advanced cancer patients’ state of grief

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 9500-9500
Author(s):  
H. G. Prigerson ◽  
A. A. Wright ◽  
S. D. Block ◽  
P. K. Maciejewski
Keyword(s):  
Medical Care ◽  
End Of Life ◽  
Advanced Cancer ◽  
Cancer Diagnosis ◽  
Chart Review ◽  
Advanced Cancer Patients ◽  
Coping With Cancer ◽  
Eol Care ◽  
Prospective Longitudinal ◽  
Prospective Longitudinal Cohort

9500 Background: Prior research has shown end-of-life (EOL) discussions are not associated with significant psychological distress, but are associated with earlier referrals to hospice and lower rates of intensive care. Nevertheless, associations between EOL discussions and care received may vary depending on patients’ state of grief over their cancer diagnosis. The aim of this study was to determine how Kubler-Ross’ proposed 5 states of grief –numbness, anger, bargaining, depression, and acceptance –modify the effects of EOL discussions on EOL care received. We hypothesized that the early grief state of numbness would interfere with patients’ processing of an EOL discussion, thereby, reducing its association with care received. Methods: Coping with Cancer is an NCI/NIMH-funded, multi-site prospective, longitudinal cohort study of patients with advanced cancer, conducted from September 2002-February 2008. Analyses were based upon 316 deceased patients who were interviewed at baseline and followed until death 4.4 months later. Patients were assessed at baseline on 5 grief states in response to their cancer diagnosis (i.e., numbness, anger, bargaining, depression, and acceptance) and whether an EOL discussion with their physician had occurred. Information on medical care received in the last week of life was obtained from chart review, and regressed on the interaction between each of the 5 grief states and the patient's report of an EOL discussion. Results: Of the 5 grief states, only numbness significantly moderated the effect of EOL discussions on medical care received. For patients with higher than average numbness (i.e., ≥ 1 on the 0–4 numbness score continuum), the effect of EOL discussions on ventilation or resuscitation in the last week of life was significantly reduced by a factor of 10 [OR=9.96, 95% CI (1.21–82.2)]; the effect of EOL discussions on death in the ICU was significantly reduced by a factor of three [OR=2.98, 95% CI (1.01–8.78)]. Conclusions: Associations between EOL discussions and care received are much reduced among patients who are high on numbness (i.e., those who have not resolved the 1st grief state). Physicians should consider their patients’ grief state (i.e., numbness) when deciding whether to engage in EOL discussions. No significant financial relationships to disclose.

Latino ethnicity, immigrant status, and preference for life-extending end-of-life cancer care.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 10028-10028
Author(s):  
Ana Isabel Tergas ◽  
Holly Gwen Prigerson ◽  
Megan Johnson Shen ◽  
Paul K Maciejewski
Keyword(s):  
End Of Life ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Multiple Logistic Regression Analysis ◽  
Latino Immigrants ◽  
Immigrant Status ◽  
Advanced Cancer Patients ◽  
Comfort Care ◽  
Coping With Cancer ◽  
Advance Care

10028 Background: Latino advanced cancer patients are less likely to engage in advance care planning, use hospice services, and receive end-of-life (EOL) care in line with their preferences compared to non-Latino advanced cancer patients. Little is known about how immigration status influences preference for life-extending care (LEC) at the EOL. Methods: Data were derived from two sequential multi-institutional, longitudinal cohort studies of patients with advanced cancer recruited from 2002 – 2008 (Coping with Cancer I [CwC-1]) and 2010 – 2015 (Coping with Cancer II [CwC-2]). Multiple logistic regression analysis was used to estimate effects of immigrant status and CwC cohort among Latinos, and effects of ethnicity and CwC cohort among US-born Latinos and non-Latino whites, on preference for LEC at the EOL. Results: Of the 760 studied cancer patients, 661 were US-born non-Latino (US non-L), 34 were US-born Latino (USL) and 65 were Latino immigrants (LI). LI were less educated (mean years of education: 7.8 years) than USL (11.1 years), who were in turn less educated than US non-L (13.7 years). Far fewer LI had insurance compared to USL (18.5% vs. 64.7%, respectively; p < 0.001), and fewer USL had insurance compared to US non-L (64.7% vs. 81.4%, respectively; p = 0.017). Within CwC-2, LI had higher odds of preferring LEC over comfort care compared to USL (adjusted odds ratio [AOR] = 9.4; 95% CI: 1.2, 72.4), and USL had lower odds of preferring LEC compared to US non-L (AOR = 0.3; 95% CI: 0.1, 1.0). LI from CwC-2 had higher odds of preferring LEC compared to LI from CwC-1 (AOR = 11.4; 95% CI: 2.7, 48.4), but there was no difference between USL from CwC-2 and USL from CwC-1. US non-L from CwC-2 had higher odds of preferring LEC compared to US non-L from CwC-1 (AOR = 3.9; 95% CI: 2.6, 5.9). Within CwC-1, there was no difference in LEC preference between LI and USL, nor between USL and US non-L. Conclusions: Immigrant status has a strong effect on preference for life-extending care among the more recent cohort of Latino cancer patients. Preference for life-extending care appears to have increased significantly over time for Latino immigrants, but remained unchanged for US-born Latinos. Latino immigrants may increasingly want life-extending care near death.

Time Perception of Cancer Patients Without Evidence of Disease and Advanced Cancer Patients in a Palliative, End-of-Life-Care Setting

2011 ◽  
Vol 34 (6) ◽  
pp. 453-463 ◽  
Author(s):  
Hanneke W. M. van Laarhoven ◽  
Johannes Schilderman ◽  
Constans A. H. H. V. M. Verhagen ◽  
Judith B. Prins
Keyword(s):  
End Of Life ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Time Perception ◽  
End Of Life Care ◽  
Care Setting ◽  
Life Care ◽  
Advanced Cancer Patients

scholarly journals Shifting Palliative Care Paradigm in Primary Care From Better Death to Better End-of-Life : A Swiss Pilot Study

2021 ◽  
Author(s):  
Johanna Sommer ◽  
Christopher Chung ◽  
Dagmar M. Haller ◽  
Sophie Pautex
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Palliative Care ◽  
Pilot Study ◽  
End Of Life ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Communication Skills ◽  
Advanced Cancer Patients

Abstract Background: Patients suffering from advanced cancer often loose contact with their primary care physician (PCP) during oncologic treatment and palliative care is introduced very late.The aim of this pilot study was to test the feasibility and procedures for a randomized trial of an intervention to teach PCPs a palliative care approach and communication skills to improve advanced cancer patients’ quality of life. Methods: Observational pilot study in 5 steps. 1) Recruitment of PCPs. 2) Intervention: training on palliative care competencies and communication skills addressing end-of-life issues.3) Recruitment of advanced cancer patients by PCPs. 4) Patients follow-up by PCPs, and assessment of their quality of life by a research assistant 5) Feedback from PCPs using a semi-structured focus group and three individual interviews with qualitative deductive theme analysis.Results: 8 PCPs were trained. PCPs failed to recruit patients for fear of imposing additional loads on their patients. PCPs changed their approach of advanced cancer patients. They became more conscious of their role and responsibility during oncologic treatments and felt empowered to take a more active role picking up patient’s cues and addressing advance directives. They developed interprofessional collaborations for advance care planning. Overall, they discovered the role to help patients to make decisions for a better end-of-life.Conclusions: PCPs failed to recruit advanced cancer patients, but reported a change in paradigm about palliative care. They moved from a focus on helping patients to die better, to a new role helping patients to define the conditions for a better end-of-life.Trial registration : The ethics committee of the canton of Geneva approved the study (2018-00077 Pilot Study) in accordance with the Declaration of Helsinki

How long do I have? Observational study on communication about life expectancy with advanced cancer patients

2017 ◽  
Vol 100 (10) ◽  
pp. 1820-1827 ◽  
Author(s):  
I. Henselmans ◽  
E.M.A. Smets ◽  
P.K.J. Han ◽  
H.C.J.C. de Haes ◽  
H.W.M.van Laarhoven
Keyword(s):  
Life Expectancy ◽  
Observational Study ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Advanced Cancer Patients
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