Patient characteristics associated with prognostic awareness: a study of a Canadian palliative care population using the InterRAI palliative care instrument

TitlePatient characteristics associated with prognostic awareness: a study of a Canadian palliative care population using the InterRAI palliative care instrument
Publication TypeJournal Article
Year of Publication2015
AuthorsFisher K., Seow H., Cohen J., Declercq A., Freeman S., Guthrie D.M
JournalJ Pain Symptom Manage
Volume49
Issue4
Pagination716-25
Date PublishedApr
ISBN Number0885-3924
Accession Number25220047
Keywords*Awareness, Adolescent, Adult, Aged, Cross-Sectional Studies, Female, Health Knowledge, Attitudes, Practice, Humans, interRAI palliative care assessment, Logistic Models, Male, Middle Aged, Ontario, palliative care, Palliative Care/*methods/*psychology, predictors of prognostic awareness, Prognosis, Prognostic awareness, psychological well-being, Young Adult
Abstract

CONTEXT: Awareness of their medical prognosis enables terminally ill patients to make decisions on treatments and end-of-life care/planning, and to reach acceptance. Yet, many patients receiving palliative care (PC) are unaware of their prognosis, even when death is imminent and has been discussed with health care providers. A better understanding of patient characteristics associated with prognostic awareness (PA) is needed to develop interventions aimed at improving it. OBJECTIVES: To identify patient characteristics associated with PA in a PC population. METHODS: The sample comprised 2090 palliative home care patients in Ontario, Canada, assessed using the interRAI Palliative Care Assessment. Independent variables included sociodemographic, cognitive/physical functioning, mood, psychological well-being, and social support. Using cross-sectional data, an adjusted logistic regression model was developed to identify key patient characteristics associated with PA. A multifaceted definition of PA was assumed and represented dichotomously in the model. Multiple imputation was used to address missing data, generating results similar to the complete case analysis. RESULTS: The PA was higher in patients with: a shorter prognosis (odds ratio [OR] 2.90, 95% confidence interval [CI] 1.93-4.33), increased hours of informal care (OR 1.71, 95% CI 1.15-2.52), less cognitive impairment (OR 1.61, 95% CI 1.14-2.28), and in patients at peace with life (OR 1.79, 95% CI 1.27-2.53). Site differences were observed but do not reflect differences in age, gender, prognosis, or diagnosis. CONCLUSION: Some patient characteristics are amenable to clinical intervention to raise PA, such as being at peace, cognitive impairment, and depression. Prognostic communications vary in timing and quality and may underlie our site differences, but further research is required to confirm this.

URLhttps://www.ncbi.nlm.nih.gov/pubmed/25220047
DOI10.1016/j.jpainsymman.2014.08.008
Alternate JournalJournal of pain and symptom management