{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T05:08:00Z","timestamp":1791522480277,"version":"4.3.4"},"reference-count":32,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2022,10,6]],"date-time":"2022-10-06T00:00:00Z","timestamp":1665014400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007652","name":"Singapore Millennium Foundation","doi-asserted-by":"publisher","award":["2015\u2010SMF\u20100003"],"award-info":[{"award-number":["2015\u2010SMF\u20100003"]}],"id":[{"id":"10.13039\/501100007652","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Little research has examined changes in prognostic awareness (PA) in the last year of life and the extent PA change was associated with anxiety, depression, and spiritual well\u2010being among metastatic cancer patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Two surveys were administered in the last year of life to 176 conveniently sampled Singaporean patients with stage 4 solid cancers. PA was assessed by asking patients whether they were aware that their treatments were unlikely to cure their cancer. Multivariable linear regression models were used to investigate the association of PA change with anxiety, depression, and spiritual well\u2010being.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The proportion of patients with accurate PA increased (39.2%\u201345.5%; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05) from the second\u2010last assessment to the last assessment before death. Those with inaccurate PA decreased (26.1%\u201320.4%; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05) while a third of patients remained uncertain at both assessments (34.7% and 34.1%). Compared to patients with inaccurate PA at both assessments, patients who reported accurate PA at both assessments reported worsened anxiety (<jats:italic>\u03b2<\/jats:italic>\u00a0=\u00a02.08), depression (<jats:italic>\u03b2<\/jats:italic>\u00a0=\u00a03.87), and spiritual well\u2010being (<jats:italic>\u03b2<\/jats:italic>\u00a0=\u00a0\u22124.45) while patients who reported being uncertain about their prognosis at both assessments reported worsened spiritual well\u2010being (<jats:italic>\u03b2<\/jats:italic>\u00a0=\u00a0\u2212 6.30) at the last assessment before death (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05 for all).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Interventions should dually focus on decreasing prognostic uncertainty at the end\u2010of\u2010life while minimising the psychological and spiritual sequelae associated with being prognostically aware. More research is needed to clarify the causes of prognostic uncertainty.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cam4.5286","type":"journal-article","created":{"date-parts":[[2022,10,6]],"date-time":"2022-10-06T12:35:55Z","timestamp":1665059755000},"page":"4801-4808","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Prognostic awareness and its association with health outcomes in the last year of life"],"prefix":"10.1002","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7556-1601","authenticated-orcid":false,"given":"Semra","family":"Ozdemir","sequence":"first","affiliation":[{"name":"Lien Centre for Palliative Care Duke\u2010NUS Medical School  Singapore"},{"name":"Signature Programme in Health Services and Systems Research Duke\u2010NUS Medical School  Singapore"},{"name":"Saw Swee Hock School of Public Health National University of Singapore  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isha","family":"Chaudhry","sequence":"additional","affiliation":[{"name":"Lien Centre for Palliative Care Duke\u2010NUS Medical School  Singapore"},{"name":"Signature Programme in Health Services and Systems Research Duke\u2010NUS Medical School  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean","family":"Ng","sequence":"additional","affiliation":[{"name":"Lien Centre for Palliative Care Duke\u2010NUS Medical School  Singapore"},{"name":"Signature Programme in Health Services and Systems Research Duke\u2010NUS Medical School  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Teo","sequence":"additional","affiliation":[{"name":"Lien Centre for Palliative Care Duke\u2010NUS Medical School  Singapore"},{"name":"Signature Programme in Health Services and Systems Research Duke\u2010NUS Medical School  Singapore"},{"name":"National Cancer Centre Singapore  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5380-0525","authenticated-orcid":false,"given":"Chetna","family":"Malhotra","sequence":"additional","affiliation":[{"name":"Lien Centre for Palliative Care Duke\u2010NUS Medical School  Singapore"},{"name":"Signature Programme in Health Services and Systems Research Duke\u2010NUS Medical School  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric Andrew","family":"Finkelstein","sequence":"additional","affiliation":[{"name":"Lien Centre for Palliative Care Duke\u2010NUS Medical School  Singapore"},{"name":"Signature Programme in Health Services and Systems Research Duke\u2010NUS Medical School  Singapore"},{"name":"Saw Swee Hock School of Public Health National University of Singapore  Singapore"},{"name":"Duke Global Health Institute Duke University  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"COMPASS Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,10,6]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/neuonc\/nox117"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjspcare-2020-002287"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2009.25.4672"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/pon.3346"},{"issue":"629050","key":"e_1_2_10_6_1","first-page":"1","article-title":"Prognostic awareness in advanced disease: a review update and concept analysis","volume":"12","author":"K\u00fchne F","year":"2021","journal-title":"Front Psychol"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2019.7525"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2019.06.022"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2020.07.023"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2021.0238"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1038\/bmt.2015.113"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/pon.3943"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/nop\/npaa021"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/1049909120905789"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/0269216311429042"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.28369"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2016.71.3404"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2013.10.016"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2011.0099"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-018-4356-z"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1099-1166(200003)15:3<234::AID-GPS99>3.0.CO;2-G"},{"issue":"10","key":"e_1_2_10_22_1","first-page":"1","article-title":"Eastern cooperative oncology group performance status","volume":"5","author":"Gerard T","year":"2012","journal-title":"Chemotherapy"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2008.02.015"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.psy.41.6.500"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1177\/1049909116630985"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.1983.tb09716.x"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1207\/S15324796ABM2401_06"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1177\/070674370004500204"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2702.2011.03842.x"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1177\/1359105313484782"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1186\/1477-7525-6-46"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2017.06.009"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2006.9.1359"}],"container-title":["Cancer Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cam4.5286","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/cam4.5286","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cam4.5286","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T16:55:38Z","timestamp":1747673738000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/cam4.5286"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,6]]},"references-count":32,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2023,2]]}},"alternative-id":["10.1002\/cam4.5286"],"URL":"https:\/\/doi.org\/10.1002\/cam4.5286","archive":["Portico"],"relation":{},"ISSN":["2045-7634","2045-7634"],"issn-type":[{"value":"2045-7634","type":"print"},{"value":"2045-7634","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,6]]},"assertion":[{"value":"2022-04-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-09-12","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-10-06","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}