1
|
Carmona-Bayonas A, Rodriguez-Gonzalez A, García-García T, Velasco-Durantez V, Hernández-San Gil R, Cruz-Castellanos P, Fernandez-Montes A, Castillo-Trujillo A, Ballester I, Rogado J, Calderon C, Jimenez-Fonseca P. Can Oncologists Prompt Patient Prognostic Awareness to Enhance Decision-Making? Data From the NEOetic Study. Oncologist 2023; 28:986-995. [PMID: 37185783 PMCID: PMC10628594 DOI: 10.1093/oncolo/oyad100] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 03/21/2023] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION Anti-neoplastic therapy improves the prognosis for advanced cancer, albeit it is not curative. An ethical dilemma that often arises during patients' first appointment with the oncologist is to give them only the prognostic information they can tolerate, even at the cost of compromising preference-based decision-making, versus giving them full information to force prompt prognostic awareness, at the risk of causing psychological harm. METHODS We recruited 550 participants with advanced cancer. After the appointment, patients and clinicians completed several questionnaires about preferences, expectations, prognostic awareness, hope, psychological symptoms, and other treatment-related aspects. The aim was to characterize the prevalence, explanatory factors, and consequences of inaccurate prognostic awareness and interest in therapy. RESULTS Inaccurate prognostic awareness affected 74%, conditioned by the administration of vague information without alluding to death (odds ratio [OR] 2.54; 95% CI, 1.47-4.37, adjusted P = .006). A full 68% agreed to low-efficacy therapies. Ethical and psychological factors oriented first-line decision-making, in a trade-off in which some lose quality of life and mood, for others to gain autonomy. Imprecise prognostic awareness was associated with greater interest in low-efficacy treatments (OR 2.27; 95% CI, 1.31-3.84; adjusted P = .017), whereas realistic understanding increased anxiety (OR 1.63; 95% CI, 1.01-2.65; adjusted P = 0.038), depression (OR 1.96; 95% CI, 1.23-3.11; adjusted P = .020), and diminished quality of life (OR 0.47; 95% CI, 0.29-0.75; adjusted P = .011). CONCLUSION In the age of immunotherapy and targeted therapies, many appear not to understand that antineoplastic therapy is not curative. Within the mix of inputs that comprise inaccurate prognostic awareness, many psychosocial factors are as relevant as the physicians' disclosure of information. Thus, the desire for better decision-making can actually harm the patient.
Collapse
Affiliation(s)
- Alberto Carmona-Bayonas
- Department of Medical Oncology, Hospital Universitario Morales Meseguer, University of Murcia, UMU, IMIB, Murcia, Spain
| | - Adán Rodriguez-Gonzalez
- Department of Medical Oncology, Hospital Universitario Central de Asturias, ISPA, Faculty of Medicine, University of Oviedo, Oviedo, Spain
| | - Teresa García-García
- Department of Medical Oncology, Hospital General Universitario Santa Lucia, Cartagena, Spain
| | - Verónica Velasco-Durantez
- Department of Medical Oncology, Hospital Universitario Central de Asturias, ISPA, Oviedo, Faculty of Medicine, University of Valladolid, Valladolid, Spain
| | | | | | - Ana Fernandez-Montes
- Department of Medical Oncology, Complejo Hospitalario Universitario de Ourense, Orense, Spain
| | - Alfredo Castillo-Trujillo
- Department of Medical Oncology, Hospital Universitario Central de Asturias, ISPA, Faculty of Medicine, University of Oviedo, Oviedo, Spain
| | - Inmaculada Ballester
- Department of Medical Oncology, Hospital Universitario Morales Meseguer, University of Murcia, UMU, IMIB, Murcia, Spain
| | - Jacobo Rogado
- Department of Medical Oncology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Caterina Calderon
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology. University of Barcelona, Spain
| | - Paula Jimenez-Fonseca
- Department of Medical Oncology, Hospital Universitario Central de Asturias, ISPA, Faculty of Medicine, University of Oviedo, Oviedo, Spain
| |
Collapse
|
2
|
Wiersma M, Ghinea N, Kerridge I, Lipworth W. 'Treat them into the grave': cancer physicians' attitudes towards the use of high-cost cancer medicines at the end of life. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41:343-359. [PMID: 30460710 DOI: 10.1111/1467-9566.12830] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The prescribing of high-cost cancer medicines at the end of life has become a focus of criticism, due primarily to concerns about the safety, efficacy and cost-effectiveness of these medicines in this clinical context. In response to these concerns, a number of interventions have been proposed - frequently focused on improving physician-patient communication at the end of life. Underpinning these strategies is the assumption that the prescribing of high-cost cancer medicines at the end of life is primarily the result of poor communication on the part of cancer physicians. In this paper, we explore the factors perceived by cancer physicians to be driving the use of high-cost cancer medicines at the end of life. Drawing on semi-structured interviews with 16 Australian oncologists and haematologists, we demonstrate that these physicians believe that the use of high-cost medicines at the end of life is driven by multiple factors - including individual, interpersonal, socio-cultural and public policy influences. We conclude that these factors, and their interactions, need to be taken into account in the development of public policy and clinical interventions to address the use of high-cost medicines at the end of life.
Collapse
Affiliation(s)
- Miriam Wiersma
- Sydney Health Ethics, The University of Sydney, Sydney, NSW, Australia
| | - Narcyz Ghinea
- Sydney Health Ethics, The University of Sydney, Sydney, NSW, Australia
| | - Ian Kerridge
- Sydney Health Ethics, The University of Sydney, Sydney, NSW, Australia
- Haematology Department, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Wendy Lipworth
- Sydney Health Ethics, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|