Prognostic beliefs in patients with cancer receiving outpatient palliative care

Prognostic awareness refers to a patient's knowledge of their prognosis. Since this term implies that there is a knowable truth about survival, we propose utilizing the more neutral construct of "prognostic beliefs." We aimed to assess prognostic beliefs of patients with cancer receiving palliative care and their relationship to: i) recall of physician-communicated prognosis, ii) physical/psychological well-being, and iii) actual survival.

Participants were recruited in the outpatient palliative care clinic of a comprehensive cancer center in Toronto, Canada. Eligibility criteria were: ≥ 18 years, English-speaking, diagnosed with cancer, and receiving palliative care. Group comparisons of well-being were conducted using independent samples t-tests.

188 participants completed physical and psychosocial well-being questionnaires and the Prognostic Beliefs Questionnaire. 167/188 participants (88.8%) recalled discussing treatability/curability and 81 (43.1%) recalled discussing expected survival with their physician. Among 147 participants who rated treatability/curability, 129 (87.8%) had prognostic beliefs concordant with their recall of physician communication, none had worse prognostic beliefs than their oncologist, and 18 (12.2%) had better prognostic beliefs. Of 77 participants who rated expected survival, 58 (75.3%) had concordant prognostic beliefs, 1 (1.3%) had worse beliefs, and 18 (23.4%) had better beliefs. Among 66 participants who died, 45 (68.2%) were realistic regarding survival time, 12 (18.2%) had more pessimistic beliefs, and 9 (13.6%) had more optimistic beliefs.

Patients with cancer receiving palliative care tend to have realistic prognostic beliefs about the treatability and curability of their disease and their expected survival, without adverse effects of this knowledge on their well-being.