Measuring a patient's understanding of their prognosis: An exploratory analysis Journal Article


Authors: Rosenfeld, B.; Walsh, L. E.; Zhu, D.; Cham, H.; Polacek, L. C.; Duva, M. M.; Applebaum, A. J.
Article Title: Measuring a patient's understanding of their prognosis: An exploratory analysis
Abstract: Objective In patients with cancer across the illness trajectory, treatment decisions are often influenced by one's perception of their prognosis (i.e., curability of disease, life expectancy, quality of life). However, research on how patients understand their prognosis (i.e., prognostic understanding) has been limited by simplistic measurement tools that fail to capture the complexity of the construct. This study describes the initial development of a measure of prognostic understanding: the Prognostic Understanding Perceptions Scale (PUPS) for use in patients with advanced cancer. Method An initial pool of 16 candidate items were developed through semi-structured interviews with 15 experts (oncology, psycho-oncology and palliative care professionals) and 30 advanced cancer patients. We investigated the dimensionality, internal item structure, item difficulty and item discrimination of the item pool using exploratory factor analysis (EFA), classical test theory (CTT) and item response theory (IRT) analyses. Convergent and divergent validity were based on correlations between PUPS, terminal illness acknowledgement, and self-report measures of depression, anxiety, hopelessness, and death acceptance. Results The final measure was comprised of nine items encompassing three factors (perceived curability, illness trajectory, treatment options), yielding strong psychometric properties. Conclusion These results provide preliminarily support for PUPS as a multifaceted measure of prognostic understanding developed for use in patients with advanced cancer. Preliminary findings also highlight the potential utility of the PUPS for clinical settings, as a means of enhancing communication between patients and physicians. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
Keywords: advanced cancer; oncology; psycho-oncology; terminal illness; cancer; prognosis; prognostic understanding
Journal Title: Psycho-Oncology
Volume: 31
Issue: 10
ISSN: 1057-9249
Publisher: John Wiley & Sons  
Date Published: 2022-10-01
Start Page: 1790
End Page: 1798
Language: English
ACCESSION: 2022-93813-001
DOI: 10.1002/pon.6007
PROVIDER: Ovid Technologies
PROVIDER: psycinfo
PUBMED: 35950542
PMCID: PMC9547961
DOI/URL:
Notes: Source: APA PsycInfo
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  1. Allison Joyce Applebaum
    191 Applebaum
  2. Laura Christine Polacek
    26 Polacek
  3. Leah Elizabeth Walsh
    21 Walsh