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JAMA. 1998 Jun 3;279(21):1709-14.

Relationship between cancer patients' predictions of prognosis and their treatment preferences.

Author information

  • 1Department of Adult Oncology, Dana-Farber Cancer Institute, Boston, MA 02115-6084, USA. janevweeks@dci.harvard.edu

Erratum in

  • JAMA 2000 Jan 12;283(2):203.

Abstract

CONTEXT:

Previous studies have documented that cancer patients tend to overestimate the probability of long-term survival. If patient preferences about the trade-offs between the risks and benefits associated with alternative treatment strategies are based on inaccurate perceptions of prognosis, then treatment choices may not reflect each patient's true values.

OBJECTIVE:

To test the hypothesis that among terminally ill cancer patients an accurate understanding of prognosis is associated with a preference for therapy that focuses on comfort over attempts at life extension.

DESIGN:

Prospective cohort study.

SETTING:

Five teaching hospitals in the United States.

PATIENTS:

A total of 917 adults hospitalized with stage III or IV non-small cell lung cancer or colon cancer metastatic to liver in phases 1 and 2 of the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT).

MAIN OUTCOME MEASURES:

Proportion of patients favoring life-extending therapy over therapy focusing on relief of pain and discomfort, patient and physician estimates of the probability of 6-month survival, and actual 6-month survival.

RESULTS:

Patients who thought they were going to live for at least 6 months were more likely (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.8-3.7) to favor life-extending therapy over comfort care compared with patients who thought there was at least a 10% chance that they would not live 6 months. This OR was highest (8.5; 95% CI, 3.0-24.0) among patients who estimated their 6-month survival probability at greater than 90% but whose physicians estimated it at 10% or less. Patients overestimated their chances of surviving 6 months, while physicians estimated prognosis quite accurately. Patients who preferred life-extending therapy were more likely to undergo aggressive treatment, but controlling for known prognostic factors, their 6-month survival was no better.

CONCLUSIONS:

Patients with metastatic colon and lung cancer overestimate their survival probabilities and these estimates may influence their preferences about medical therapies.

Comment in

PMID:
9624023
[PubMed - indexed for MEDLINE]
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