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Randomized Controlled Trial
. 2020 Jul;60(1):20-27.
doi: 10.1016/j.jpainsymman.2020.02.005. Epub 2020 Feb 13.

Associations of Caregiver-Oncologist Discordance in Prognostic Understanding With Caregiver-Reported Therapeutic Alliance and Anxiety

Kah Poh Loh  1 , Huiwen Xu  2 , Ronald M Epstein  3 , Supriya G Mohile  2 , Holly G Prigerson  4 , Sandra Plumb  2 , Susan Ladwig  5 , Sindhuja Kadambi  2 , Melisa L Wong  6 , Colin McHugh  2 , Amy An  5 , Kelly Trevino  7 , Fahad Saeed  8 , Paul R Duberstein  9
Affiliations
Randomized Controlled Trial

Associations of Caregiver-Oncologist Discordance in Prognostic Understanding With Caregiver-Reported Therapeutic Alliance and Anxiety

Kah Poh Loh et al. J Pain Symptom Manage. 2020 Jul.

Abstract

Context: Discordance in prognostic understanding between caregivers of adults with advanced cancer and the oncologist may shape caregivers' views of the oncologist and bereavement outcomes.

Objectives: We examined prospective associations of caregiver-oncologist discordance with caregiver-oncologist therapeutic alliance and caregiver anxiety after patient death.

Methods: We conducted a secondary analysis of data collected in a cluster randomized controlled trial from August 2012 to June 2014 in Western New York and California. At enrollment, caregivers and oncologists used a seven-point scale to rate their beliefs about the patient's curability and living two years or more: 100%, about 90%, about 75%, about 50 of 50, about 25%, about 10%, and 0%. Discordance was defined as a difference of two points or more. Outcomes at seven months after patient death included caregiver-oncologist therapeutic alliance (The Human Connection scale, modified into five items) and caregiver anxiety (Generalized Anxiety Disorder-7). We conducted multivariable linear regression models to assess the independent associations of discordance with alliance and anxiety.

Results: We included 97 caregivers (mean age 63) and 38 oncologists; 41% of caregiver-oncologist dyads had discordant beliefs about the patient's curability, and 63% of caregiver-oncologist dyads had discordant beliefs about living two years or more. On multivariate analysis, discordance in beliefs about curability was associated with lower anxiety (β = -2.20; SE 0.77; P = 0.005). Discordance in beliefs about length of life was associated with a weaker alliance (β = -5.87; SE = 2.56; P = 0.02).

Conclusion: A better understanding of how caregivers understand and come to terms with poor prognoses will guide interventions to improve cancer care delivery and outcomes of cancer treatment.

Keywords: Discordance; anxiety; beliefs about curability; beliefs about length of life; therapeutic alliance.

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Conflict of interest statement

Disclosure/Conflict of Interest: Dr. Loh has served as a consultant to Seattle Genetics and Pfizer. All other authors have no relevant conflicts of interest to report.

Competing interests: No competing interests

Figures

Figure 1:
Figure 1:
Distribution of caregiver and oncologist A) beliefs about curability and B) beliefs about length of life
See this image and copyright information in PMC

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