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...

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Autores principales:	Chen Hsiu Chen, Fur‐Hsing Wen, Wen‐Chi Chou, Jen‐Shi Chen, Wen‐Cheng Chang, Chia‐Hsun Hsieh, Siew Tzuh Tang
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	end‐of‐life care neoplasms oncology prognostic awareness transition patterns Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/904f0138e19241728587c9f8acd5bf29
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spelling	oai:doaj.org-article:904f0138e19241728587c9f8acd5bf292021-11-22T09:08:47ZFactors associated with distinct prognostic‐awareness‐transition patterns over cancer patients’ last 6 months of life2045-763410.1002/cam4.4321https://doaj.org/article/904f0138e19241728587c9f8acd5bf292021-11-01T00:00:00Zhttps://doi.org/10.1002/cam4.4321https://doaj.org/toc/2045-7634Abstract 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.Chen Hsiu ChenFur‐Hsing WenWen‐Chi ChouJen‐Shi ChenWen‐Cheng ChangChia‐Hsun HsiehSiew Tzuh TangWileyarticleend‐of‐life careneoplasmsoncologyprognostic awarenesstransition patternsNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENCancer Medicine, Vol 10, Iss 22, Pp 8029-8039 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	end‐of‐life care neoplasms oncology prognostic awareness transition patterns Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	end‐of‐life care neoplasms oncology prognostic awareness transition patterns Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 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
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.
format	article
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
title	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_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_sort	factors associated with distinct prognostic‐awareness‐transition patterns over cancer patients’ last 6 months of life
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/904f0138e19241728587c9f8acd5bf29
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Factors associated with distinct prognostic‐awareness‐transition patterns over cancer patients’ last 6 months of life

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