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Associations among awareness of prognosis, hopefulness, and coping in patients with advanced cancer participating in phase I clinical trials

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Abstract

Goals

There is considerable debate concerning prognosis in patients with advanced cancer (advanced cancer patients, ACP), but no one has systematically examined the relationship between awareness of prognosis and hopefulness. In this study, the relationships among awareness of prognosis, hopefulness, and coping were examined in a selected group of ACP.

Patients and methods

All subjects were enrolled in phase I trials. Information was obtained from subjects via structured, face-to-face interviews. Subjects provided demographic information, answered questions designed to ascertain their awareness of their prognosis, and completed the Functional Assessment of Cancer Therapy—General instrument (FACT-G).

Results

A total of 179 consecutive subjects enrolled in phase I trials were interviewed. Awareness of prognosis was assessed using a semiquantitative scale. Willingness to provide responses to the question was significantly negatively correlated with hopefulness (r=−0.306, P=0.030). Using items from the FACT-G, hopefulness and coping were positively correlated (r=0.140, P=0.097). Female subjects were more realistic about their prognosis than men (b=0.568, P=0.026). More educated patients had higher response rates to the prognosis questions (OR 1.62, P<0.001), and demonstrated a more realistic awareness of prognosis (b=0.225, P=0.030). Overall, there was a strong association between coping status and responding to the prognosis questions (P=0.033). Patients who reported being "not at all proud of coping" had a lower response rate than patients who reported better coping.

Discussion

Among the ACP who provided responses, many reported an unrealistic view of their prognosis. Having a more accurate view of prognosis in the face of terminal illness was associated with reduced hopefulness, which may be related to a poorer sense of coping. Finally, the prognosis question utilized in the study was problematic, led to a fairly poor response rate, and may be indicative of the many difficulties present in attempting to accurately assess ACPs' perceptions of their prognosis. Other methods, such as in-depth qualitative methods, may lead to more productive inquiry into ACPs' awareness of their prognosis. Further research into the accurate assessment of awareness of prognosis is needed.

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Author information

Authors and Affiliations

  1. Department of Medicine, The Regenstrief Institute for Health Care, Indiana University School of Medicine, Indianapolis, Indiana, USA

    Paul R. Helft

  2. Indiana University Center for Bioethics, Indiana University School of Medicine, Indianapolis, Indiana, USA

    Paul R. Helft

  3. Department of Medicine, The University of Chicago, Chicago, Illinois, USA

    Fay Hlubocky & Christopher K. Daugherty

  4. The MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, Illinois, USA

    Christopher K. Daugherty

  5. Cancer Research Center, The University of Chicago, Chicago, Illinois, USA

    Christopher K. Daugherty

  6. Department of Health Studies, The University of Chicago, Chicago, Illinois, USA

    Ming Wen

  7. Division of Hematology/Oncology, Indiana University School of Medicine, 535 Barnhill Drive, RT 473, Indianapolis, IN 46202, USA

    Paul R. Helft

  8. Section of Hematology/Oncology, The University of Chicago, 5841 S. Maryland Avenue, MC 2115, Chicago, IL 60637, USA

    Fay Hlubocky, Ming Wen & Christopher K. Daugherty

Authors
  1. Paul R. Helft
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  2. Fay Hlubocky
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  3. Ming Wen
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  4. Christopher K. Daugherty
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Corresponding author

Correspondence to Paul R. Helft.

Additional information

This work was supported by grants from the American Society of Clinical Oncology (C.K.D., Career Development Award) and the NIH (C.K.D., RO1 CA 087605-01A1)

Appendix: questions used to assess awareness of prognosis

Appendix: questions used to assess awareness of prognosis

I am now going to ask you some pretty difficult questions about the possibility of death from your cancer. If you wish, you do not have to answer the questions.

  1. 1.

    I am going to read four statements about the possibility of your death occurring from your cancer. I would like you to tell me which of the four statements best describes your feelings as to the chances of your death occurring from your cancer. [Read the statements and then code on the table below]

  2. 2.

    Now I would like you to tell me which of the four statements best describes your feelings as to the chances of your death occurring from your cancer within the next 5 years. [Read the statements and then code on the table below]

  3. 3.

    Now I would like you to tell me which of the four statements best describes your feelings as to the chances of your death occurring from your cancer within the next year. [Read the statements and then code on the table below]

The statements relating to questions 1–3 are shown in Table 6.

Table 6. Assessing awareness of prognosis (statements relating to questions 1–3 of the Appendix)
Full size table

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Helft, P.R., Hlubocky, F., Wen, M. et al. Associations among awareness of prognosis, hopefulness, and coping in patients with advanced cancer participating in phase I clinical trials. Support Care Cancer 11, 644–651 (2003). https://doi.org/10.1007/s00520-003-0496-y

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  • DOI: https://doi.org/10.1007/s00520-003-0496-y

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