We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Transitions in Prognostic Awareness Among Terminally Ill Cancer Patients in Their Last 6 Months of Life Examined by Multi-State Markov Modeling.
- Authors
Hsiu Chen, Chen; Wen, Fur‐Hsing; Hou, Ming‐Mo; Hsieh, Chia‐Hsun; Chou, Wen‐Chi; Chen, Jen‐Shi; Chang, Wen‐Cheng; Tang, Siew Tzuh
- Abstract
Background. Developing accurate prognostic awareness, a cornerstone of preference-based end-of-life (EOL) care decision-making, is a dynamic process involving more prognostic-awareness states than knowing or not knowing. Understanding the transition probabilities and time spent in each prognostic-awareness state can help clinicians identify trigger points for facilitating transitions toward accurate prognostic awareness. We examined transition probabilities in distinct prognostic-awareness states between consecutive time points in 247 cancer patients' last 6 months and estimated the time spent in each state. Methods. Prognostic awareness was categorized into four states: (a) unknown and not wanting to know, state 1; (b) unknown but wanting to know, state 2; (c) inaccurate awareness, state 3; and (d) accurate awareness, state 4. Transitional probabilities were examined by multistate Markov modeling. Results. Initially, 59.5% of patients had accurate prognostic awareness, whereas the probabilities of being in states 1-3 were 8.1%, 17.4%, and 15.0%, respectively. Patients' prognostic awareness generally remained unchanged (probabilities of remaining in the same state: 45.5%-92.9%). If prognostic awareness changed, it tended to shift toward higher prognostic-awareness states (probabilities of shifting to state 4 were 23.2%-36.6% for patients initially in states 1-3, followed by probabilities of shifting to state 3 for those in states 1 and 2 [9.8%-10.1%]). Patients were estimated to spend 1.29, 0.42, 0.68, and 3.61 months in states 1-4, respectively, in their last 6 months. Conclusion. Terminally ill cancer patients' prognostic awareness generally remained unchanged, with a tendency to become more aware of their prognosis. Health care professionals should facilitate patients' transitions toward accurate prognostic awareness in a timely manner to promote preference-based EOL decisions.
- Subjects
TUMOR diagnosis; CANCER patients; LONGITUDINAL method; MEDICAL needs assessment; METASTASIS; PROBABILITY theory; PROGNOSIS; RESEARCH funding; TERMINALLY ill; HEALTH literacy; PATIENTS' attitudes
- Publication
Oncologist, 2017, Vol 22, Issue 9, p1135
- ISSN
1083-7159
- Publication type
Article
- DOI
10.1634/theoncologist.2017-0068