Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore.
Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.
Psychooncology. 2021 May;30(5):780-788. doi: 10.1002/pon.5675. Epub 2021 Apr 1.
Many patients with advanced illness are unrealistically optimistic about their prognosis. We test for the presence of several cognitive biases, including optimism bias, illusion of superiority, self-deception, misattribution, and optimistic update bias, that could explain unrealistically optimistic prognostic beliefs among advanced cancer patients and quantifies the extent to which hope exacerbates these biases.
A cross-sectional survey was administered to 200 advanced cancer patients with physician-estimated prognoses of one year or less. Hope was measured using the Herth Hope Index (HHI). Hypotheses were tested using linear and logistic regressions and a structural-equation model.
Results are consistent with the presence of optimism bias, illusion of superiority, self-deception, and misattribution. All of these biases are amplified by higher levels of hope. Each 1-point higher HHI is associated with a 6% (OR: 1.06; 95% CI: 1.01-1.11) greater odds of believing their illness is curable, a 0.33-year (95% CI: 0.17-0.49) longer expected survival, a 6% (OR: 1.06; 95% CI: 1.02-1.11) higher probability of believing that survival outcomes are better than the average patient, a 5% higher odds of believing primary intent of treatment is curative (OR: 1.05; 95% CI: 1.00-1.10), and a 12% (OR: 1.12; 95% CI: 1.05-1.17) higher odds of believing they are well-informed. Mediation analyses revealed that hope significantly mediates the effect of mental-well-being and loneliness on expected survival.
Results suggest advanced cancer patients succumb to several cognitive biases which are exacerbated by greater levels of hope. As a result, they are susceptible to possible over-treatment and regret.
许多患有晚期疾病的患者对自己的预后不切实际地乐观。我们测试了几种认知偏差的存在，包括乐观偏差、优越感错觉、自我欺骗、归因错误和乐观更新偏差，这些偏差可以解释晚期癌症患者不切实际的乐观预后信念，并量化了希望加剧这些偏差的程度。
对 200 名预计生存期为一年或更短的晚期癌症患者进行了横断面调查。使用赫特希望指数（HHI）测量希望。使用线性和逻辑回归以及结构方程模型检验假设。
结果与乐观偏差、优越感错觉、自我欺骗和归因错误的存在一致。所有这些偏差都被更高的希望水平放大了。HHI 每增加 1 分，患者相信自己的疾病可以治愈的可能性就增加 6%（OR：1.06；95%CI：1.01-1.11），预计生存时间延长 0.33 年（95%CI：0.17-0.49），认为自己的生存结果比平均患者更好的可能性增加 6%（OR：1.06；95%CI：1.02-1.11），认为治疗的主要目的是治愈的可能性增加 5%（OR：1.05；95%CI：1.00-1.10），认为自己了解情况的可能性增加 12%（OR：1.12；95%CI：1.05-1.17）。中介分析显示，希望显著中介了心理健康和孤独感对预期生存的影响。
结果表明，晚期癌症患者容易受到几种认知偏差的影响，而这些偏差会因希望水平的增加而加剧。因此，他们容易受到过度治疗和遗憾的影响。
