Prognostic Awareness in Caregivers of Patients with Incurable Cancer.

Abstract

<b><i>Background:</i></b> Little is known about how patients with incurable cancer and caregivers differ in their prognostic awareness, and the relationship between caregiver prognostic awareness and their psychological distress. <b><i>Objective:</i></b> To investigate prognostic awareness in caregivers of patients with incurable cancer and prognostic discordance in patient-caregiver dyads and its association with psychological distress. <b><i>Design:</i></b> This is a cross-sectional study. <b><i>Setting/Subjects:</i></b> In total, subjects were 390 caregivers of adults with incurable lung, gastrointestinal, and brain cancers at a cancer center in the northeastern United States. <b><i>Measurements:</i></b> The Prognosis and Treatment Perceptions Questionnaire was used to assess prognostic awareness and Hospital Anxiety and Depression Scale to assess psychological distress. <b><i>Results:</i></b> In total, 39.7% (<i>n</i> = 147/370) and 17.3% (<i>n</i> = 64/370) caregivers reported clinically significant anxiety and depression symptoms. And 53.7% of caregivers reported the patients' cancer as "curable" and 44.1% reported the cancer was "not terminal." Caregivers' report of curability was not associated with their anxiety (odds ratio [OR] = 0.99, <i>p</i> = 0.93) or depression (OR = 1.05, <i>p</i> = 0.32) symptoms. Among 42.5% (124/292) and 26.0% (76/292) of dyads (<i>n</i> = 292), both patients and their caregivers agreed in their perception of the cancer as curable and incurable, respectively. In 19.9% of dyads (<i>n</i> = 58), patients reported their cancer as curable, while their caregivers reported it as incurable. In 11.6% of dyads (<i>n</i> = 34), patients reported the cancer as incurable while caregivers reported it as curable. <b><i>Conclusions:</i></b> More than half of caregivers have misperceptions about the patients' likelihood of cure, and one-third of patient-caregiver dyads have discordant perceptions. Supportive care interventions may facilitate conversations and enhance prognostic understanding in patients with incurable cancer and their caregivers.