Advanced cancer patients' changes in accurate prognostic understanding and their psychological well-being Journal Article
| Authors: | George, L. S.; Maciejewski, P. K.; Epstein, A. S.; Shen, M.; Prigerson, H. G. |
| Article Title: | Advanced cancer patients' changes in accurate prognostic understanding and their psychological well-being |
| Abstract: | Context: Clinicians often worry that patients' recognition of the terminal nature of their illness may impair psychological well-being. Objectives: To determine if such recognition was associated with decrements to psychological well-being that persisted over time. Methods: About 87 patients with advanced cancer, with an oncologist-expected life expectancy of less than six months, were assessed before and after an oncology visit to discuss cancer restaging scan results and again at follow-up (median time between assessments, approximately six weeks). Prognostic understanding (PU) was assessed at previsit and postvisit, and a change score was computed. Psychological well-being was assessed at pre, post, and follow-up, and two change scores were computed (post minus pre; follow-up minus post). Results: Changes toward more accurate PU was associated with a corresponding initial decline in psychological well-being (r = −0.33; P < 0.01) but thereafter was associated with subsequent improvements (r = 0.40; P < 0.001). This pattern remained controlling for potential confounds. Patients showed different patterns of psychological well-being change (F = 3.07, P = 0.05; F = 6.54, P < 0.01): among patients with improved PU accuracy, well-being initially decreased but subsequently recovered; by contrast, among patients with stable PU accuracy, well-being remained relatively unchanged, and among patients with decrements in PU accuracy, well-being initially improved but subsequently declined. Conclusion: Improved PU may be associated with initial decrements in psychological well-being, followed by patients rebounding to baseline levels. Concerns about lasting psychological harm may not need to be a deterrent to having prognostic discussions with patients. © 2020 American Academy of Hospice and Palliative Medicine |
| Keywords: | adult; middle aged; major clinical study; advanced cancer; cancer patient; follow up; quality of life; lung cancer; digestive system cancer; depression; longitudinal studies; fear; psychotrauma; life expectancy; comprehension; female genital tract cancer; psychological; adaptation; cancer prognosis; prognosis; human; male; female; article; patient worry; sadness; psychological well-being |
| Journal Title: | Journal of Pain and Symptom Management |
| Volume: | 59 |
| Issue: | 5 |
| ISSN: | 0885-3924 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2020-05-01 |
| Start Page: | 983 |
| End Page: | 989 |
| Language: | English |
| DOI: | 10.1016/j.jpainsymman.2019.12.366 |
| PUBMED: | 31887399 |
| PROVIDER: | scopus |
| PMCID: | PMC7186137 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 May 2020 -- Source: Scopus |
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