TY - JOUR
T1 - Patient and caregiver agreement on prognosis estimates for older adults with advanced cancer
AU - Loh, Kah Poh
AU - Soto Pérez de Celis, Enrique
AU - Duberstein, Paul R.
AU - Culakova, Eva
AU - Epstein, Ronald M.
AU - Xu, Huiwen
AU - Kadambi, Sindhuja
AU - Flannery, Marie
AU - Magnuson, Allison
AU - McHugh, Colin
AU - Trevino, Kelly M.
AU - Tuch, Gina
AU - Ramsdale, Erika
AU - Yousefi-Nooraie, Reza
AU - Sedenquist, Margaret
AU - Liu, Jane Jijun
AU - Melnyk, Nataliya
AU - Geer, Jodi
AU - Mohile, Supriya G.
N1 - Funding Information:
This work was supported by the Patient‐Centered Outcomes Research Institute (PCORI) Program (contract 4634 to Supriya G. Mohile), grants from the National Cancer Institute at the National Institutes of Health (UG1 CA189961; R01CA168387 to Paul R. Duberstein; K99CA237744 to Kah Poh Loh), grants from the National Institute of Aging at the National Institutes of Health (K24 AG056589 to Supriya G. Mohile; R21 AG059206 to Supriya G. Mohile; K76 AG064394 to Allison Magnuson), and the Wilmot Research Fellowship Award (to Kah Poh Loh). This work was made possible by generous donors to the Wilmot Cancer Institute Geriatric Oncology Philanthropy Fund.
Funding Information:
Kah Poh Loh reports personal fees from Pfizer and Seattle Genetics, outside the submitted work. Eva Cluakova reports grants from the National Cancer Institute, outside the submitted work. Supriya G. Mohile reports personal fees from Seattle Genetics and research funding from Carevive, outside the submitted work. The remaining authors made no disclosures.
Publisher Copyright:
© 2020 American Cancer Society
PY - 2020/1/1
Y1 - 2020/1/1
N2 - Background: Disagreements between patients and caregivers about treatment benefits, care decisions, and patients' health are associated with increased patient depression as well as increased caregiver anxiety, distress, depression, and burden. Understanding the factors associated with disagreement may inform interventions to improve the aforementioned outcomes. Methods: For this analysis, baseline data were obtained from a cluster-randomized geriatric assessment trial that recruited patients aged ≥70 years who had incurable cancer from community oncology practices (University of Rochester Cancer Center 13070; Supriya G. Mohile, principal investigator). Patient and caregiver dyads were asked to estimate the patient's prognosis. Response options were 0 to 6 months, 7 to 12 months, 1 to 2 years, 2 to 5 years, and >5 years. The dependent variable was categorized as exact agreement (reference), patient-reported longer estimate, or caregiver-reported longer estimate. The authors used generalized estimating equations with multinomial distribution to examine the factors associated with patient-caregiver prognostic estimates. Independent variables were selected using the purposeful selection method. Results: Among 354 dyads (89% of screened patients were enrolled), 26% and 22% of patients and caregivers, respectively, reported a longer estimate. Compared with dyads that were in agreement, patients were more likely to report a longer estimate when they screened positive for polypharmacy (β = 0.81; P =.001), and caregivers reported greater distress (β = 0.12; P =.03). Compared with dyads that were in agreement, caregivers were more likely to report a longer estimate when patients screened positive for polypharmacy (β = 0.82; P =.005) and had lower perceived self-efficacy in interacting with physicians (β = −0.10; P =.008). Conclusions: Several patient and caregiver factors were associated with patient-caregiver disagreement about prognostic estimates. Future studies should examine the effects of prognostic disagreement on patient and caregiver outcomes.
AB - Background: Disagreements between patients and caregivers about treatment benefits, care decisions, and patients' health are associated with increased patient depression as well as increased caregiver anxiety, distress, depression, and burden. Understanding the factors associated with disagreement may inform interventions to improve the aforementioned outcomes. Methods: For this analysis, baseline data were obtained from a cluster-randomized geriatric assessment trial that recruited patients aged ≥70 years who had incurable cancer from community oncology practices (University of Rochester Cancer Center 13070; Supriya G. Mohile, principal investigator). Patient and caregiver dyads were asked to estimate the patient's prognosis. Response options were 0 to 6 months, 7 to 12 months, 1 to 2 years, 2 to 5 years, and >5 years. The dependent variable was categorized as exact agreement (reference), patient-reported longer estimate, or caregiver-reported longer estimate. The authors used generalized estimating equations with multinomial distribution to examine the factors associated with patient-caregiver prognostic estimates. Independent variables were selected using the purposeful selection method. Results: Among 354 dyads (89% of screened patients were enrolled), 26% and 22% of patients and caregivers, respectively, reported a longer estimate. Compared with dyads that were in agreement, patients were more likely to report a longer estimate when they screened positive for polypharmacy (β = 0.81; P =.001), and caregivers reported greater distress (β = 0.12; P =.03). Compared with dyads that were in agreement, caregivers were more likely to report a longer estimate when patients screened positive for polypharmacy (β = 0.82; P =.005) and had lower perceived self-efficacy in interacting with physicians (β = −0.10; P =.008). Conclusions: Several patient and caregiver factors were associated with patient-caregiver disagreement about prognostic estimates. Future studies should examine the effects of prognostic disagreement on patient and caregiver outcomes.
KW - caregivers
KW - disagreement
KW - geriatric oncology
KW - older patients
KW - prognostic estimates
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U2 - 10.1002/cncr.33259
DO - 10.1002/cncr.33259
M3 - Article
C2 - 33036063
AN - SCOPUS:85092131868
SN - 0008-543X
VL - 127
SP - 149
EP - 159
JO - Cancer
JF - Cancer
IS - 1
ER -