Effects of Perception of Prognosis on Existential Well-Being and Ego-Integrity Among Advanced Cancer Patients
People suffering from advanced illness tend to react differently to the actual threat to life.
One of the overwhelming sources of such threat is the awareness of a life limiting prognosis.
Previous work on advanced cancer patients’ awareness of prognosis concluded,
that doctors frequently make errors in prognostication, usually towards optimism.
This is not surprising, considering that the topic of death and dying can be an area
of discomfort for many health professionals.
This over-optimistic bias in prognostication may, in part, explain why patients
often appear to have unrealistic expectations of survival, and hold a far more
overestimation of prognosis than their oncologists.
For instance, studies revealed that 82% of stage 4 cancer patients perceive their prognosis
as much better than their oncologists. It was also found, that awareness of prognosis
is not necessarily an outcome of the information given by the physician.
In addition, although physicians’ propensity to discuss prognosis was associated with better
awareness by patients, still rather few eventually articulated a realistic estimation of their prognosis.
Several studies have consistently found evidence of over-optimistic perception
of prognosis among advanced cancer patients. For example, when patients with advanced colon
and lung cancer, were asked to estimate their numeric probability of 6-month survival,
more than 75% of the sample estimated their likelihood to be at least 90%.10
In a similar study, only 33% of the sample admitted awareness of the high likelihood
of death from cancer within 5 years, and only 16% admitted awareness of death within one year.
Thus, overwhelmingly, patients in both studies placed themselves into the most
optimistic category provided by the instrument or interview.
Palliat Med Hosp Care Open J. 2017; SE(1): S59-S67. doi: 10.17140/PMHCOJ-SE-1-113
