TY - JOUR
T1 - Association Between Caregiver-Oncologist Discordance in Patient's Life Expectancy Estimates and Caregiver Perceived Autonomy Support by the Oncologist
AU - Tuch, Gina
AU - Sanapala, Chandrika
AU - Mohile, Supriya G.
AU - Duberstein, Paul R.
AU - Soto-Perez-de-Celis, Enrique
AU - Xu, Huiwen
AU - Culakova, Eva
AU - Flannery, Marie
AU - Yousefi-Nooraie, Reza
AU - Epstein, Ronald M.
AU - McHugh, Colin
AU - Aarne, Valerie
AU - Kim, Hannah
AU - Geer, Jodi
AU - O'Rourke, Mark A.
AU - Vogelzang, Nicholas J.
AU - Loh, Kah Poh
N1 - Funding Information:
We acknowledge Dr. Susan Rosenthal, M.D., for her editorial assistance. The study was selected for oral presentation at the 2020 American Geriatrics Society Annual Meeting and delivered during the virtual Clin‐STAR session. The work was supported by the Patient‐Centered Outcomes Research Institute (PCORI) Program contract (4634 to S.G.M.), the National Cancer Institute at the National Institutes of Health (UG1 CA189961); R01CA168387 to PRD; K99CA237744 to K.P.L.), the National Institute of Aging at the National Institutes of Health (K24 AG056589 to S.G.M.; R33 AG059206 to S.G.M.), and the Wilmot Research Fellowship Award (grant number is not applicable; to K.P.L.). This work was made possible by the generous donors to the Wilmot Cancer Institute geriatric oncology philanthropy fund. All statements in this report, including its findings and conclusions, are solely those of the authors, do not necessarily represent the official views of the funding agencies, and do not necessarily represent the views of the PCORI, its Board of Governors, or Methodology Committee.
Publisher Copyright:
© 2021 AlphaMed Press.
PY - 2021/11
Y1 - 2021/11
N2 - Background: Caregiver perceived autonomy support by the oncologist is important for caregiver well-being and may be affected by the patient's survival. We determined the association of caregiver-oncologist discordance in patient's life expectancy estimates with perceived autonomy support over time and whether the association differed by patient survival status. Materials and Methods: We used data from a geriatric assessment cluster-randomized trial (URCC 13070) that recruited patients aged at least 70 years with incurable cancer considering or receiving treatment, their caregivers, and their oncologists. At baseline, caregivers and oncologists were asked to estimate patient's life expectancy (0–6 months, 7–12 months, 1–2 years, 2–5 years, and >5 years; any difference in response was considered discordant). At 4–6 weeks, 3 months, and 6 months, caregivers completed the Health Care Climate Questionnaire (HCCQ), which measured perceived autonomy support by the oncologist. Generalized estimating equation modeling was conducted to assess the association of baseline caregiver-oncologist discordance with longitudinal HCCQ scores, stratified by patient 6-month survival status. Results: Discordant life expectancy estimates were present in 72.0% of dyads. In multivariate analyses, caregiver-oncologist discordance in patient's life expectancy estimates was associated with higher caregiver HCCQ scores. In stratified analysis, caregiver-oncologist discordance was associated with lower caregiver HCCQ scores (β = −3.46; 95% CI, −4.64 to −2.29) among patients who died within 6 months but with higher caregiver HCCQ scores (β = 1.33; 95% CI, 0.63–2.04) among patients who survived beyond 6 months. Conclusion: Interventions aimed at mitigating discordance need to consider its association with caregiver perceived autonomy support and patient's survival in order to better inform caregiver expectations. Implications for Practice: Among patients who died within the first 6 months, caregivers who estimated a different length of life for the patient compared with oncologists were more likely to report lower support from the oncologist, whereas the opposite relationship was seen within patients who survived beyond the first 6 months. When designing interventions to improve caregiver understanding of the patient's prognosis, its relationship with caregiver-perceived support and patient's survival needs to be considered.
AB - Background: Caregiver perceived autonomy support by the oncologist is important for caregiver well-being and may be affected by the patient's survival. We determined the association of caregiver-oncologist discordance in patient's life expectancy estimates with perceived autonomy support over time and whether the association differed by patient survival status. Materials and Methods: We used data from a geriatric assessment cluster-randomized trial (URCC 13070) that recruited patients aged at least 70 years with incurable cancer considering or receiving treatment, their caregivers, and their oncologists. At baseline, caregivers and oncologists were asked to estimate patient's life expectancy (0–6 months, 7–12 months, 1–2 years, 2–5 years, and >5 years; any difference in response was considered discordant). At 4–6 weeks, 3 months, and 6 months, caregivers completed the Health Care Climate Questionnaire (HCCQ), which measured perceived autonomy support by the oncologist. Generalized estimating equation modeling was conducted to assess the association of baseline caregiver-oncologist discordance with longitudinal HCCQ scores, stratified by patient 6-month survival status. Results: Discordant life expectancy estimates were present in 72.0% of dyads. In multivariate analyses, caregiver-oncologist discordance in patient's life expectancy estimates was associated with higher caregiver HCCQ scores. In stratified analysis, caregiver-oncologist discordance was associated with lower caregiver HCCQ scores (β = −3.46; 95% CI, −4.64 to −2.29) among patients who died within 6 months but with higher caregiver HCCQ scores (β = 1.33; 95% CI, 0.63–2.04) among patients who survived beyond 6 months. Conclusion: Interventions aimed at mitigating discordance need to consider its association with caregiver perceived autonomy support and patient's survival in order to better inform caregiver expectations. Implications for Practice: Among patients who died within the first 6 months, caregivers who estimated a different length of life for the patient compared with oncologists were more likely to report lower support from the oncologist, whereas the opposite relationship was seen within patients who survived beyond the first 6 months. When designing interventions to improve caregiver understanding of the patient's prognosis, its relationship with caregiver-perceived support and patient's survival needs to be considered.
KW - Autonomy support
KW - Caregiver-oncologist discordance
KW - Geriatric oncology
KW - Patient's life expectancy estimates
KW - Survival
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U2 - 10.1002/onco.13913
DO - 10.1002/onco.13913
M3 - Article
C2 - 34309111
AN - SCOPUS:85112190992
SN - 1083-7159
VL - 26
SP - e1992-e2001
JO - Oncologist
JF - Oncologist
IS - 11
ER -