Chay Junxing, Huynh Vinh Anh, Cheung Yin Bun, Kanesvaran Ravindran, Lee Lai Heng, Malhotra Chetna, Finkelstein Eric Andrew
Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore.
Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.
Front Psychol. 2023 May 23;14:1151976. doi: 10.3389/fpsyg.2023.1151976. eCollection 2023.
Among those with advanced illness, higher levels of hope may offer physiological benefits. Yet, greater levels of hope may also encourage aggressive treatments. Therefore, higher levels of hope may lead to greater healthcare utilization, higher expenditure, and longer survival. We test these hypotheses among patients with advanced cancer.
A secondary data analysis from a cross-sectional survey of 195 advanced cancer patients with high mortality risk linked to subsequent healthcare utilization (outpatient, day surgeries, non-emergency admissions), health expenditures, and death records. The survey collected data on hope, measured generally by the Herth Hope Index (HHI) and more narrowly by two questions on illness-related hope. Generalized linear regression and Cox models were used to test our hypotheses.
142 (78%) survey participants died during the period of analysis, with close to half (46%) doing so within a year of the survey. Contrary to expectation, HHI scores did not have a significant association with healthcare utilization, expenditure or survival. Yet, illness-related hope, defined as those who expected to live at least 2 years, as opposed to the likely prognosis of 1 year or less as determined by the primary treating oncologist, had 6.6 more planned hospital encounters (95% CI 0.90 to 12.30) in the 12-months following the survey and 41% lower mortality risk (hazard ratio: 0.59, 95% CI 0.36 to 0.99) compared to those who were less optimistic. Secondary analysis among decedents showed that patients who believed that the primary intent of their treatment is curative, had higher total expenditure (S$30,712; 95% CI S$3,143 to S$58,282) in the last 12 months of life than those who did not have this belief.
We find no evidence of a relationship between a general measure of hope and healthcare utilization, expenditure, or survival among advanced cancer patients. However, greater illness-related hope is positively associated with these outcomes.
在患有晚期疾病的人群中，较高水平的希望可能带来生理益处。然而，更高水平的希望也可能促使采取积极的治疗措施。因此，更高水平的希望可能导致更高的医疗保健利用率、更高的支出和更长的生存期。我们在晚期癌症患者中检验这些假设。
对195名具有高死亡风险的晚期癌症患者进行横断面调查的二次数据分析，这些数据与随后的医疗保健利用情况（门诊、日间手术、非紧急住院）、医疗支出和死亡记录相关联。该调查收集了关于希望的数据，一般通过赫思希望指数（HHI）进行衡量，更具体地通过关于疾病相关希望的两个问题进行衡量。使用广义线性回归和Cox模型来检验我们的假设。
142名（78%）调查参与者在分析期间死亡，近一半（46%）在调查后一年内死亡。与预期相反，HHI得分与医疗保健利用、支出或生存期没有显著关联。然而，与主要治疗肿瘤学家确定的可能预后为1年或更短时间相反，将疾病相关希望定义为那些预期至少能活2年的人，在调查后的12个月内计划进行的医院就诊次数比那些不太乐观的人多6.6次（95%置信区间0.90至12.30），死亡风险降低41%（风险比：0.59，95%置信区间0.36至0.99）。对死者的二次分析表明，那些认为其治疗的主要目的是治愈的患者，在生命的最后12个月的总支出（30,712新元；95%置信区间3,143新元至58,282新元）高于那些没有这种信念的患者。
我们没有发现晚期癌症患者中希望的总体衡量指标与医疗保健利用、支出或生存期之间存在关系的证据。然而，更高的疾病相关希望与这些结果呈正相关。
