Accurate View of Prognosis Ensures Terminally Ill Make Value-Consistent EOL-Care Decisions
Prognostic awareness affects EOL decisions and can impact quality of life.
Approximately 60% of terminally ill patients have accurate prognostic awareness of their condition and tend to become more aware as their condition deteriorates, according to a study published in The Oncologist.
Prognostic awareness is an important aspect of decision making at end of life (EOL) that allows for better quality of life and care, and prepares patients for death.
The researchers differentiated prognostic awareness into 4 states: unknown and not wanting to know; unknown but wanting to know; inaccurate awareness; accurate awareness. The study followed 247 patients with cancer during the last 6 months of care, and estimated the time patients spent in each state, as well as the likelihood of transitioning between states. Patients were interviewed every 2 weeks to determine their awareness.
The results showed that initially 8.1% of patients did not know and did not want to know, 17.4% did not know but wanted to know, and 15.0% of patients viewed their prognosis inaccurately.
Patients' prognostic awareness stayed relatively stable, particularly for those who were accurately aware. If patients transitioned, they were generally into a higher state of prognostic awareness. At time of death, the investigators found that 81.8% of patients were accurately aware vs any other state.
The investigators add that clinicians should begin to develop patients' awareness earlier on as terminally ill cancer patients need time to understand their prognosis clearly. They conclude by saying, “Such timely and sensitive interventions would ensure that patients make full use of prognostic information in making informed and value-consistent EOL-care decisions.”
1. Chen CH, Wen FH, Hou MM, et al. Transitions in prognostic awareness among terminally ill cancer patients in their last 6 months of life examined by multi-state Markov modeling [published online July 6, 2017]. Oncologist. doi: 10.1634/theoncologist.2017-0068