Krueger Ellen, Mosher Catherine E, Lewson Ashley, Hickman Susan E, Wu Wei, Prigerson Holly G
Division of Neuropsychology, Department of Neurology (E.K.), Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Department of Psychology (C.E.M., A.L., W.W.), Indiana University Indianapolis, Indianapolis, Indiana, USA.
J Pain Symptom Manage. 2025 Sep;70(3):313-323.e3. doi: 10.1016/j.jpainsymman.2025.06.002. Epub 2025 Jun 10.
Patients who are prognostically aware are more likely to receive end-of-life care consistent with their values. However, prognostic awareness has shown mixed associations with patients' quality-of-life (QoL) outcomes. Theory suggests that acceptance of cancer may moderate relationships between prognostic awareness and outcomes of QoL and end-of-life treatment preferences. Patients' degree of prognostic awareness and illness acceptance may also impact their family caregivers' QoL and end-of-life treatment preferences for the patient.
To examine the potential moderating role of patient acceptance of cancer in the relationships between patient prognostic awareness and both patient and caregiver QoL and end-of-life treatment preferences.
A cross-sectional, secondary analysis was conducted using data from patients with advanced cancer (n = 243) and their caregivers (n = 87) in the multi-institutional Coping with Cancer-II cohort study. Patient physical, psychological, and existential QoL were examined in a moderation path analysis. Caregiver physical and psychological QoL were examined in separate linear regression analyses. Patient and caregiver end-of-life treatment preferences were examined in multiple logistic regression moderation models.
No significant moderations were found. Greater patient illness acceptance was associated with better patient QoL outcomes and caregiver psychological QoL but was unrelated to end-of-life treatment preferences. Greater patient prognostic awareness was associated with worse patient physical QoL and both patients' and caregivers' preference for comfort care.
Increasing patients' prognostic awareness and cancer acceptance may improve values-consistent end-of-life care and patient and caregiver QoL outcomes. Findings support timely conversations to promote prognostic awareness and further testing of acceptance-based interventions in advanced cancer.
对预后有认知的患者更有可能接受符合其价值观的临终关怀。然而，预后认知与患者的生活质量（QoL）结果之间的关联并不一致。理论表明，对癌症的接受程度可能会调节预后认知与生活质量结果以及临终治疗偏好之间的关系。患者的预后认知程度和对疾病的接受程度也可能影响其家庭照顾者的生活质量以及对患者临终治疗的偏好。
探讨患者对癌症的接受程度在患者预后认知与患者及照顾者生活质量和临终治疗偏好之间关系中的潜在调节作用。
在多机构开展的“应对癌症-II”队列研究中，对晚期癌症患者（n = 243）及其照顾者（n = 87）的数据进行横断面二次分析。在调节路径分析中考察患者的身体、心理和存在方面的生活质量。在单独的线性回归分析中考察照顾者的身体和心理生活质量。在多个逻辑回归调节模型中考察患者和照顾者的临终治疗偏好。
未发现显著的调节作用。患者对疾病的接受程度越高，其生活质量结果越好，照顾者的心理生活质量也越好，但与临终治疗偏好无关。患者的预后认知程度越高，其身体生活质量越差，患者和照顾者对舒适护理的偏好也越高。
提高患者的预后认知和对癌症的接受程度可能会改善符合价值观的临终关怀以及患者和照顾者的生活质量结果。研究结果支持及时进行沟通以提高预后认知，并对晚期癌症患者基于接受的干预措施进行进一步测试。
