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Palliat Med. 2017 May;31(5):406-418. doi: 10.1177/0269216316663976. Epub 2016 Aug 4.

Current status of accurate prognostic awareness in advanced/terminally ill cancer patients: Systematic review and meta-regression analysis.

Chen CH1,2, Kuo SC2,3, Tang ST4,5,6.

Author information

1
1 Department of Nursing, University of Kang Ning, Tainan, Taiwan.
2
2 Graduate Institute of Clinical Medical Science, Chang Gung University, Tao-Yuan, Taiwan.
3
3 Department of Nursing, Yuanpei University, Hsinchu, Taiwan.
4
4 School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
5
5 Department of Nursing, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
6
6 Division of Hematology-Oncology, Chang Gung Memorial Hospital, Linkou, Tao-Yuan, Taiwan.

Abstract

BACKGROUND:

No systematic meta-analysis is available on the prevalence of cancer patients' accurate prognostic awareness and differences in accurate prognostic awareness by publication year, region, assessment method, and service received.

AIM:

To examine the prevalence of advanced/terminal cancer patients' accurate prognostic awareness and differences in accurate prognostic awareness by publication year, region, assessment method, and service received.

DESIGN:

Systematic review and meta-analysis.

METHODS:

MEDLINE, Embase, The Cochrane Library, CINAHL, and PsycINFO were systematically searched on accurate prognostic awareness in adult patients with advanced/terminal cancer (1990-2014). Pooled prevalences were calculated for accurate prognostic awareness by a random-effects model. Differences in weighted estimates of accurate prognostic awareness were compared by meta-regression.

RESULTS:

In total, 34 articles were retrieved for systematic review and meta-analysis. At best, only about half of advanced/terminal cancer patients accurately understood their prognosis (49.1%; 95% confidence interval: 42.7%-55.5%; range: 5.4%-85.7%). Accurate prognostic awareness was independent of service received and publication year, but highest in Australia, followed by East Asia, North America, and southern Europe and the United Kingdom (67.7%, 60.7%, 52.8%, and 36.0%, respectively; pā€‰=ā€‰0.019). Accurate prognostic awareness was higher by clinician assessment than by patient report (63.2% vs 44.5%, pā€‰<ā€‰0.001).

CONCLUSION:

Less than half of advanced/terminal cancer patients accurately understood their prognosis, with significant variations by region and assessment method. Healthcare professionals should thoroughly assess advanced/terminal cancer patients' preferences for prognostic information and engage them in prognostic discussion early in the cancer trajectory, thus facilitating their accurate prognostic awareness and the quality of end-of-life care decision-making.

KEYWORDS:

Prognosis; accurate prognostic awareness; awareness; neoplasms

PMID:
27492160
DOI:
10.1177/0269216316663976
[Indexed for MEDLINE]

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