Factors associated with distinct prognostic‐awareness‐transition patterns over cancer patients’ last 6 months of life
Abstract Background Cancer patients may develop prognostic awareness (PA) heterogeneously, but predictors of PA‐transition patterns have never been studied. We aimed to identify transition patterns of PA and their associated factors during cancer patients’ last 6 months. Methods For this secondary‐a...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-11-01
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| Series: | Cancer Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/cam4.4321 |
| _version_ | 1818999769270321152 |
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| author | Chen Hsiu Chen Fur‐Hsing Wen Wen‐Chi Chou Jen‐Shi Chen Wen‐Cheng Chang Chia‐Hsun Hsieh Siew Tzuh Tang |
| author_facet | Chen Hsiu Chen Fur‐Hsing Wen Wen‐Chi Chou Jen‐Shi Chen Wen‐Cheng Chang Chia‐Hsun Hsieh Siew Tzuh Tang |
| author_sort | Chen Hsiu Chen |
| collection | DOAJ |
| description | Abstract Background Cancer patients may develop prognostic awareness (PA) heterogeneously, but predictors of PA‐transition patterns have never been studied. We aimed to identify transition patterns of PA and their associated factors during cancer patients’ last 6 months. Methods For this secondary‐analysis study, PA was assessed among 334 cancer patients when they were first diagnosed as terminally ill and monthly till they died. PA was categorized into four states: (a) unknown and not wanting to know; (b) unknown but wanting to know; (c) inaccurate awareness; and (d) accurate awareness. The first and last PA states estimated by hidden Markov modeling were examined to identify their change patterns. Factors associated with distinct PA‐transition patterns were determined by multinomial logistic regressions focused on modifiable time‐varying variables assessed in the wave before the last PA assessment to ensure a clear time sequence for associating with PA‐transition patterns. Results Four PA‐transition patterns were identified: maintaining accurate PA (56.3%), gaining accurate PA (20.4%), heterogeneous PA (7.8%), and still avoiding PA (15.6%). Reported physician‐prognostic disclosure increased the likelihood of belonging to the maintaining‐accurate‐PA group than to other groups. Greater symptom distress predisposed patients to be in the still‐avoiding‐PA than the heterogeneous PA group. Patients with higher functional dependence and more anxiety/depressive symptoms were more and less likely to be in the heterogeneous PA group and in the still‐avoiding‐PA group, respectively, than in the maintaining‐ and gaining‐accurate PA groups. Conclusions Cancer patients heterogeneously experienced PA‐transition patterns over their last 6 months. Physicians’ prognostic disclosure, and patients’ symptom distress, functional dependence, and anxiety/depressive symptoms, all modifiable by high‐quality end‐of‐life care, were associated with distinct PA‐transition patterns. |
| first_indexed | 2024-12-20T22:22:41Z |
| format | Article |
| id | doaj.art-904f0138e19241728587c9f8acd5bf29 |
| institution | Directory Open Access Journal |
| issn | 2045-7634 |
| language | English |
| last_indexed | 2024-12-20T22:22:41Z |
| publishDate | 2021-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Medicine |
| spelling | doaj.art-904f0138e19241728587c9f8acd5bf292022-12-21T19:24:54ZengWileyCancer Medicine2045-76342021-11-0110228029803910.1002/cam4.4321Factors associated with distinct prognostic‐awareness‐transition patterns over cancer patients’ last 6 months of lifeChen Hsiu Chen0Fur‐Hsing Wen1Wen‐Chi Chou2Jen‐Shi Chen3Wen‐Cheng Chang4Chia‐Hsun Hsieh5Siew Tzuh Tang6School of Nursing National Taipei University of Nursing and Health Sciences Taipei TaiwanDepartment of International Business Soochow University Taipei TaiwanDivision of Hematology‐Oncology Chang Gung Memorial Hospital Tao‐Yuan TaiwanDivision of Hematology‐Oncology Chang Gung Memorial Hospital Tao‐Yuan TaiwanDivision of Hematology‐Oncology Chang Gung Memorial Hospital Tao‐Yuan TaiwanDivision of Hematology‐Oncology Chang Gung Memorial Hospital Tao‐Yuan TaiwanDivision of Hematology‐Oncology Chang Gung Memorial Hospital Tao‐Yuan TaiwanAbstract Background Cancer patients may develop prognostic awareness (PA) heterogeneously, but predictors of PA‐transition patterns have never been studied. We aimed to identify transition patterns of PA and their associated factors during cancer patients’ last 6 months. Methods For this secondary‐analysis study, PA was assessed among 334 cancer patients when they were first diagnosed as terminally ill and monthly till they died. PA was categorized into four states: (a) unknown and not wanting to know; (b) unknown but wanting to know; (c) inaccurate awareness; and (d) accurate awareness. The first and last PA states estimated by hidden Markov modeling were examined to identify their change patterns. Factors associated with distinct PA‐transition patterns were determined by multinomial logistic regressions focused on modifiable time‐varying variables assessed in the wave before the last PA assessment to ensure a clear time sequence for associating with PA‐transition patterns. Results Four PA‐transition patterns were identified: maintaining accurate PA (56.3%), gaining accurate PA (20.4%), heterogeneous PA (7.8%), and still avoiding PA (15.6%). Reported physician‐prognostic disclosure increased the likelihood of belonging to the maintaining‐accurate‐PA group than to other groups. Greater symptom distress predisposed patients to be in the still‐avoiding‐PA than the heterogeneous PA group. Patients with higher functional dependence and more anxiety/depressive symptoms were more and less likely to be in the heterogeneous PA group and in the still‐avoiding‐PA group, respectively, than in the maintaining‐ and gaining‐accurate PA groups. Conclusions Cancer patients heterogeneously experienced PA‐transition patterns over their last 6 months. Physicians’ prognostic disclosure, and patients’ symptom distress, functional dependence, and anxiety/depressive symptoms, all modifiable by high‐quality end‐of‐life care, were associated with distinct PA‐transition patterns.https://doi.org/10.1002/cam4.4321end‐of‐life careneoplasmsoncologyprognostic awarenesstransition patterns |
| spellingShingle | Chen Hsiu Chen Fur‐Hsing Wen Wen‐Chi Chou Jen‐Shi Chen Wen‐Cheng Chang Chia‐Hsun Hsieh Siew Tzuh Tang Factors associated with distinct prognostic‐awareness‐transition patterns over cancer patients’ last 6 months of life Cancer Medicine end‐of‐life care neoplasms oncology prognostic awareness transition patterns |
| title | Factors associated with distinct prognostic‐awareness‐transition patterns over cancer patients’ last 6 months of life |
| title_full | Factors associated with distinct prognostic‐awareness‐transition patterns over cancer patients’ last 6 months of life |
| title_fullStr | Factors associated with distinct prognostic‐awareness‐transition patterns over cancer patients’ last 6 months of life |
| title_full_unstemmed | Factors associated with distinct prognostic‐awareness‐transition patterns over cancer patients’ last 6 months of life |
| title_short | Factors associated with distinct prognostic‐awareness‐transition patterns over cancer patients’ last 6 months of life |
| title_sort | factors associated with distinct prognostic awareness transition patterns over cancer patients last 6 months of life |
| topic | end‐of‐life care neoplasms oncology prognostic awareness transition patterns |
| url | https://doi.org/10.1002/cam4.4321 |
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