TY - JOUR
T1 - The Importance of Prognostication
T2 - Impact of Prognostic Predictions, Disclosures, Awareness, and Acceptance on Patient Outcomes
AU - Hui, David
AU - Mo, Li
AU - Paiva, Carlos Eduardo
N1 - Funding Information:
David Hui received grants from Insys and Teva. David Hui is also supported in part by grants from the National Cancer Institute (1R01CA214960-01A1; 1R01CA225701-01A1), the National Institute of Nursing Research (1R21NR016736–01), and the American Cancer Society (MRSG-14-1418-01-CCE).
Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature.
PY - 2021/2
Y1 - 2021/2
N2 - In the advanced cancer setting, patients, families, and clinicians are often confronted with an uncertain future regarding treatment outcomes and survival. Greater certainty on what to expect can enhance decision-making for many personal and healthcare issues. Although 70–90% of patients with advanced cancer desire open and honest prognostic disclosure, a small proportion do not want to know. Approximately half of patients with advanced cancer have an inaccurate understanding of their illness, which could negatively impact their decision-making. In this review, we use a conceptual framework to highlight 5 key steps along the prognostic continuum, including (1) prognostic formulation, (2) prognostic disclosure, (3) prognostic awareness, (4) prognostic acceptance, and (5) prognosis-based decision-making. We shall summarize the impact of prognostic predictions, disclosure, awareness, and acceptance on various patient and caregiver outcomes, such as hope, trust, anxiety, depression, chemotherapy use, and care planning. Based on where the patient is at along the prognostic continuum, we propose 5 different subgroups (avoidance: “I don’t want to know”; discordant, “I never wanted to know”; anxious, “I don’t know what’s happening”; concerned, “I don’t like this”; acceptance, “I know how to plan ahead”). Although prognostication is not necessarily a linear process, recognizing where the patient is at cognitively and emotionally along the prognostic continuum may allow clinicians to provide personalized interventions, such as specialist palliative care and psychology referral, towards personalizing prognostic disclosure, enhancing prognostic awareness, increasing prognostic acceptance, and supporting decision-making and, ultimately, improving patient outcomes.
AB - In the advanced cancer setting, patients, families, and clinicians are often confronted with an uncertain future regarding treatment outcomes and survival. Greater certainty on what to expect can enhance decision-making for many personal and healthcare issues. Although 70–90% of patients with advanced cancer desire open and honest prognostic disclosure, a small proportion do not want to know. Approximately half of patients with advanced cancer have an inaccurate understanding of their illness, which could negatively impact their decision-making. In this review, we use a conceptual framework to highlight 5 key steps along the prognostic continuum, including (1) prognostic formulation, (2) prognostic disclosure, (3) prognostic awareness, (4) prognostic acceptance, and (5) prognosis-based decision-making. We shall summarize the impact of prognostic predictions, disclosure, awareness, and acceptance on various patient and caregiver outcomes, such as hope, trust, anxiety, depression, chemotherapy use, and care planning. Based on where the patient is at along the prognostic continuum, we propose 5 different subgroups (avoidance: “I don’t want to know”; discordant, “I never wanted to know”; anxious, “I don’t know what’s happening”; concerned, “I don’t like this”; acceptance, “I know how to plan ahead”). Although prognostication is not necessarily a linear process, recognizing where the patient is at cognitively and emotionally along the prognostic continuum may allow clinicians to provide personalized interventions, such as specialist palliative care and psychology referral, towards personalizing prognostic disclosure, enhancing prognostic awareness, increasing prognostic acceptance, and supporting decision-making and, ultimately, improving patient outcomes.
KW - Communication
KW - Disclosure
KW - Forecasting
KW - Neoplasm
KW - Outcomes assessment
KW - Palliative care
KW - Prognosis
UR - http://www.scopus.com/inward/record.url?scp=85099183045&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85099183045&partnerID=8YFLogxK
U2 - 10.1007/s11864-020-00810-3
DO - 10.1007/s11864-020-00810-3
M3 - Review article
C2 - 33432524
AN - SCOPUS:85099183045
SN - 1527-2729
VL - 22
JO - Current treatment options in oncology
JF - Current treatment options in oncology
IS - 2
M1 - 12
ER -