Changes in Prognostic Beliefs of Patients With Metastatic Cancer and Their Association With Changing Health Status
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Health Services and Systems Research, Duke-NUS Medical School, Singapore
Saw Swee Hock School of Public Health, National University of Singapore, Singapore
Duke Global Health Institute, Duke University, Durham, North Carolina
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Health Services and Systems Research, Duke-NUS Medical School, Singapore
Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Health Services and Systems Research, Duke-NUS Medical School, Singapore
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Background: Patients’ prognostic beliefs are known to influence treatment decisions. However, the evolution of these beliefs over an extended period in patients with metastatic cancer is understudied. We assessed longitudinal changes in prognostic beliefs and investigated their association with patients’ changing health status. Methods: We surveyed a cohort of 600 patients with solid metastatic cancer every 9 months, up to 54 months. At each time point, we assessed whether patients believed their current treatments would cure them (responses classified as accurate, inaccurate, or uncertain belief) and tested the association of their response with symptom burden and recent unplanned hospital admission. Results: Only 29% of patients had accurate prognostic belief at baseline, and 24% of patients changed from having accurate to uncertain/inaccurate belief at some point during follow-up. Patients who experienced greater symptom burden were less likely to report inaccurate (relative risk ratio [RRR], 0.87; 95% CI, 0.84–0.90) or uncertain prognostic belief (RRR, 0.90; 95% CI, 0.87–0.92), whereas those with a recent unplanned hospital admission were more likely to report inaccurate (RRR, 2.71; 95% CI, 1.48–4.94) or uncertain belief (RRR, 2.34; 95% CI, 1.34–4.07) compared with accurate belief. An increase in symptom burden was associated with change toward accurate belief (RRR, 1.75; 95% CI, 1.33–2.31) as opposed to no change. Conclusions: In our study of long-term changes in prognostic beliefs among patients with metastatic cancer, reported prognostic beliefs were unstable, changed from accurate to inaccurate/uncertain and vice versa, and were associated with their changing health status. Our findings imply that conversations about goals of care must occur regularly to factor in these changes.
Submitted November 18, 2022; final revision received June 21, 2023; accepted for publication June 22, 2023.
Author contributions: Conceptualization: Gupta, Malhotra. Formal analysis: Gupta, Malhotra. Methodology: Gupta, Malhotra. Supervision: Malhotra. Writing—original draft: Gupta, Malhotra. Writing—review & editing: All authors.
Data availability statement: The data that supports the findings of this study is available from the corresponding author upon reasonable request.
Disclosures: The authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.
Funding: Financial support for this study was provided by Singapore Millennium Foundation (2015-SMF-0003) and Lien Centre for Palliative Care (LCPC-IN14-0003).
Disclaimer: The funding agreements ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report.
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