Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Feb;12(4):4801-4808.
doi: 10.1002/cam4.5286. Epub 2022 Oct 6.

Prognostic awareness and its association with health outcomes in the last year of life

Semra Ozdemir  1   2   3 , Isha Chaudhry  1   2 , Sean Ng  1   2 , Irene Teo  1   2   4 , Chetna Malhotra  1   2 , Eric Andrew Finkelstein  1   2   3   5 ; COMPASS Study Group
Affiliations

Prognostic awareness and its association with health outcomes in the last year of life

Semra Ozdemir et al. Cancer Med. 2023 Feb.

Abstract

Background: Little research has examined changes in prognostic awareness (PA) in the last year of life and the extent PA change was associated with anxiety, depression, and spiritual well-being among metastatic cancer patients.

Methods: Two surveys were administered in the last year of life to 176 conveniently sampled Singaporean patients with stage 4 solid cancers. PA was assessed by asking patients whether they were aware that their treatments were unlikely to cure their cancer. Multivariable linear regression models were used to investigate the association of PA change with anxiety, depression, and spiritual well-being.

Results: The proportion of patients with accurate PA increased (39.2%-45.5%; p < 0.05) from the second-last assessment to the last assessment before death. Those with inaccurate PA decreased (26.1%-20.4%; p < 0.05) while a third of patients remained uncertain at both assessments (34.7% and 34.1%). Compared to patients with inaccurate PA at both assessments, patients who reported accurate PA at both assessments reported worsened anxiety (β = 2.08), depression (β = 3.87), and spiritual well-being (β = -4.45) while patients who reported being uncertain about their prognosis at both assessments reported worsened spiritual well-being (β = - 6.30) at the last assessment before death (p < 0.05 for all).

Conclusions: Interventions should dually focus on decreasing prognostic uncertainty at the end-of-life while minimising the psychological and spiritual sequelae associated with being prognostically aware. More research is needed to clarify the causes of prognostic uncertainty.

Keywords: anxiety; awareness; depression; policy; psychology; quality of life.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Prognostic awareness in the last two assessments before death (n = 176)
FIGURE 2
FIGURE 2
Patient outcomes for patients with accurate PA, uncertain PA or inaccurate PA in the last two assessments before death (n = 176)
See this image and copyright information in PMC

References

    1. Diamond EL, Prigerson HG, Correa DC, et al. Prognostic awareness, prognostic communication, and cognitive function in patients with malignant glioma. Neuro Oncol. 2017;19(11):1532‐1541. - PMC - PubMed
    1. Mone S, Kerr H. Prognostic awareness in advanced cancer: an integrative literature review. BMJ Support Palliat Care. 2021;11(1):53‐58. - PubMed
    1. Mack JW, Weeks JC, Wright AA, Block SD, Prigerson HG. End‐of‐life discussions, goal attainment, and distress at the end of life: predictors and outcomes of receipt of care consistent with preferences. J Clin Oncol. 2010;28(7):1203‐1208. - PMC - PubMed
    1. Ahn E, Shin DW, Choi JY, et al. The impact of awareness of terminal illness on quality of death and care decision making: a prospective nationwide survey of bereaved family members of advanced cancer patients. Psychooncology. 2013;22(12):2771‐2778. - PubMed
    1. Kühne F, Hermann M, Preisler M, Rohrmoser A, Letsch A, Goerling U. Prognostic awareness in advanced disease: a review update and concept analysis. Front Psychol. 2021;12(629050):1‐7. - PMC - PubMed

Publication types