{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T23:18:58Z","timestamp":1791328738391,"version":"4.3.1"},"reference-count":37,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2025,7,13]],"date-time":"2025-07-13T00:00:00Z","timestamp":1752364800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Lien Centre for Palliative Care","award":["LCPC-IN14-0003"],"award-info":[{"award-number":["LCPC-IN14-0003"]}]},{"DOI":"10.13039\/501100007652","name":"singapore millennium foundation","doi-asserted-by":"publisher","award":["2015-SMF-0003"],"award-info":[{"award-number":["2015-SMF-0003"]}],"id":[{"id":"10.13039\/501100007652","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Med Decis Making"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>It is unclear whether caregivers help or hinder patients\u2019 involvement in decision making and understanding of illness. We thus investigated the extent to which caregivers\u2019 preferred level of patient involvement in decision making and understanding of treatment goals are associated with those of patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We used survey data from 229 patients with metastatic cancer and their family caregivers living in Singapore spanning 2\u2009y prior to the patient\u2019s death. We used mixed-effects regressions to investigate the associations between 1) caregiver-preferred level of patient involvement (\n                      <jats:italic>\n                        t\n                        <jats:sub>-1<\/jats:sub>\n                      <\/jats:italic>\n                      ) and patient preferred and perceived level of involvement in decision making at subsequent assessments (\n                      <jats:italic>\n                        t\n                        <jats:sub>1<\/jats:sub>\n                      <\/jats:italic>\n                      ) and 2) patient and caregiver understanding of treatment goals at the same assessments (\n                      <jats:italic>\n                        t\n                        <jats:sub>1<\/jats:sub>\n                      <\/jats:italic>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Caregivers who preferred higher levels of patient involvement in decision making at\n                      <jats:italic>t<\/jats:italic>\n                      <jats:sub>\u22121<\/jats:sub>\n                      were more likely to have patients who also preferred higher levels of involvement (odds ratio [OR] = 1.19;\n                      <jats:italic>P<\/jats:italic>\n                      = 0.03) and who perceived experiencing higher levels of involvement in decision making (OR = 1.24;\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.01) at\n                      <jats:italic>\n                        t\n                        <jats:sub>1<\/jats:sub>\n                      <\/jats:italic>\n                      . Compared with an uncertain understanding of treatment goals, caregivers who had an inaccurate understanding at\n                      <jats:italic>\n                        t\n                        <jats:sub>1<\/jats:sub>\n                      <\/jats:italic>\n                      were more likely to have patients who had an inaccurate understanding (relative risk ratio [RRR] = 8.56;\n                      <jats:italic>P<\/jats:italic>\n                      = 0.03), and caregivers who had an accurate understanding at\n                      <jats:italic>\n                        t\n                        <jats:sub>1<\/jats:sub>\n                      <\/jats:italic>\n                      were more likely to have patients with an accurate understanding (RRR = 3.02;\n                      <jats:italic>P<\/jats:italic>\n                      = 0.01) at\n                      <jats:italic>\n                        t\n                        <jats:sub>1<\/jats:sub>\n                      <\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our findings suggest that caregiver preferences for patient involvement in decision making and understanding of treatment goals are significantly associated with those of patients. Enhancing caregiver education and involvement may be pivotal in improving patient participation and comprehension in the context of metastatic cancer care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Highlights<\/jats:title>\n                    <jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>Patients of caregivers who preferred higher levels of patient involvement in decision making at earlier time points were more likely to prefer and experience higher levels of involvement in decision making at subsequent assessments.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Patients of caregivers with an inaccurate understanding of treatment goals were more likely to have an inaccurate understanding, while patients of caregivers with an accurate understanding were also more likely to have an accurate understanding.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:sec>","DOI":"10.1177\/0272989x251347303","type":"journal-article","created":{"date-parts":[[2025,7,13]],"date-time":"2025-07-13T09:28:14Z","timestamp":1752398894000},"page":"873-883","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Do Caregivers of Asian Patients with Advanced Cancer Help or Hinder Patient Understanding of Illness and Involvement in Decision Making?"],"prefix":"10.1177","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7556-1601","authenticated-orcid":false,"given":"Semra","family":"Ozdemir","sequence":"first","affiliation":[{"name":"Department of Population Health Sciences, Duke University, Durham, NC, USA"},{"name":"Signature Program in Health Services and Systems Research, Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isha","family":"Chaudhry","sequence":"additional","affiliation":[{"name":"Research Associate, Lien Centre for Palliative Care, Duke-NUS Medical School, 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":"Signature Program in Health Services and Systems Research, Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Courtney","family":"Van Houtven","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences, Duke University, Durham, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric Andrew","family":"Finkelstein","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences, Duke University, Durham, NC, USA"},{"name":"Signature Program in Health Services and Systems Research, Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,7,13]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/pon.1670"},{"key":"e_1_3_3_3_2","article-title":"Family caregivers of elderly patients with cancer: understanding and minimizing the burden of care","volume":"1","author":"Haley WE.","year":"2003","unstructured":"Haley WE. 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