{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T04:58:11Z","timestamp":1772168291183,"version":"3.50.1"},"reference-count":45,"publisher":"Harborside Press, LLC","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Patients\u2019 prognostic beliefs are known to influence treatment decisions. However, the evolution of these beliefs over an extended period in patients with metastatic cancer is understudied. We assessed longitudinal changes in prognostic beliefs and investigated their association with patients\u2019 changing health status. <jats:bold>Methods:<\/jats:bold> We surveyed a cohort of 600 patients with solid metastatic cancer every 9 months, up to 54 months. At each time point, we assessed whether patients believed their current treatments would cure them (responses classified as accurate, inaccurate, or uncertain belief) and tested the association of their response with symptom burden and recent unplanned hospital admission. <jats:bold>Results:<\/jats:bold> Only 29% of patients had accurate prognostic belief at baseline, and 24% of patients changed from having accurate to uncertain\/inaccurate belief at some point during follow-up. Patients who experienced greater symptom burden were <jats:italic>less<\/jats:italic> likely to report inaccurate (relative risk ratio [RRR], 0.87; 95% CI, 0.84\u20130.90) or uncertain prognostic belief (RRR, 0.90; 95% CI, 0.87\u20130.92), whereas those with a recent unplanned hospital admission were <jats:italic>more<\/jats:italic> likely to report inaccurate (RRR, 2.71; 95% CI, 1.48\u20134.94) or uncertain belief (RRR, 2.34; 95% CI, 1.34\u20134.07) compared with accurate belief. An increase in symptom burden was associated with change toward accurate belief (RRR, 1.75; 95% CI, 1.33\u20132.31) as opposed to no change. <jats:bold>Conclusions:<\/jats:bold> In our study of long-term changes in prognostic beliefs among patients with metastatic cancer, reported prognostic beliefs were unstable, changed from accurate to inaccurate\/uncertain and vice versa, and were associated with their changing health status. Our findings imply that conversations about goals of care must occur regularly to factor in these changes.<\/jats:p>","DOI":"10.6004\/jnccn.2023.7052","type":"journal-article","created":{"date-parts":[[2023,10,12]],"date-time":"2023-10-12T19:27:09Z","timestamp":1697138829000},"page":"1021-1028.e8","source":"Crossref","is-referenced-by-count":5,"title":["Changes in Prognostic Beliefs of Patients With Metastatic Cancer and Their Association With Changing Health Status"],"prefix":"10.6004","volume":"21","author":[{"given":"Isabella","family":"Gupta","sequence":"first","affiliation":[{"name":"Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric Andrew","family":"Finkelstein","sequence":"additional","affiliation":[{"name":"Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore"},{"name":"Health Services and Systems Research, Duke-NUS 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"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Semra","family":"Ozdemir","sequence":"additional","affiliation":[{"name":"Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore"},{"name":"Health Services and Systems Research, Duke-NUS Medical School, Singapore"},{"name":"Saw Swee Hock School of Public Health, National University of Singapore, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chetna","family":"Malhotra","sequence":"additional","affiliation":[{"name":"Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore"},{"name":"Health Services and Systems Research, Duke-NUS Medical School, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"4047","reference":[{"key":"B1","series-title":"J Health Psychol","first-page":"1103","article-title":"Conceptualizing prognostic awareness in advanced cancer: a systematic review","volume":"19","author":"Applebaum AJ","year":"2014","unstructured":"Applebaum AJ, Kolva EA, Kulikowski JR,  Conceptualizing prognostic awareness in advanced cancer: a systematic review. J Health Psychol 2014;19:1103\u20131119."},{"key":"B2","series-title":"Psychooncology","first-page":"990","article-title":"Factors associated with prognostic awareness in patients with cancer: a systematic review","volume":"29","author":"Vlckova K","year":"2020","unstructured":"Vlckova K, Tuckova A, Polakova K,  Factors associated with prognostic awareness in patients with cancer: a systematic review. Psychooncology 2020;29:990\u20131003."},{"key":"B3","series-title":"Front Psychol","first-page":"629050","article-title":"Prognostic awareness in advanced disease: a review update and concept analysis","volume":"12","author":"K\u00fchne F","year":"2021","unstructured":"K\u00fchne F, Hermann M, Preisler M,  Prognostic awareness in advanced disease: a review update and concept analysis. Front Psychol 2021;12:629050."},{"key":"B4","series-title":"Palliat Med","first-page":"406","article-title":"Current status of accurate prognostic awareness in advanced\/terminally ill cancer patients: systematic review and meta-regression analysis","volume":"31","author":"Chen CH","year":"2017","unstructured":"Chen CH, Kuo SC, Tang ST. Current status of accurate prognostic awareness in advanced\/terminally ill cancer patients: systematic review and meta-regression analysis. Palliat Med 2017;31:406\u2013418."},{"key":"B5","series-title":"Clin Oncol (R Coll Radiol)","first-page":"368","article-title":"Advanced cancer patients\u2019 prognostic awareness and its association with anxiety, depression and spiritual well-being: a multi-country study in Asia","volume":"34","author":"Ozdemir S","year":"2022","unstructured":"Ozdemir S, Ng S, Wong WHM,  Advanced cancer patients\u2019 prognostic awareness and its association with anxiety, depression and spiritual well-being: a multi-country study in Asia. Clin Oncol (R Coll Radiol) 2022;34:368\u2013375."},{"key":"B6","series-title":"Palliat Med","first-page":"29","article-title":"Advanced cancer patients\u2019 prognostic information preferences: a review","volume":"23","author":"Innes S","year":"2009","unstructured":"Innes S, Payne S. Advanced cancer patients\u2019 prognostic information preferences: a review. Palliat Med 2009;23:29\u201339."},{"key":"B7","series-title":"J Clin Oncol","first-page":"1278","article-title":"Communicating with realism and hope: incurable cancer patients\u2019 views on the disclosure of prognosis","volume":"23","author":"Hagerty RG","year":"2005","unstructured":"Hagerty RG, Butow PN, Ellis PM,  Communicating with realism and hope: incurable cancer patients\u2019 views on the disclosure of prognosis. J Clin Oncol 2005;23:1278\u20131288."},{"key":"B8","series-title":"J Cancer Res Pract","first-page":"103","article-title":"Prognostic disclosure and its influence on cancer patients","volume":"1","author":"Chen CH","year":"2014","unstructured":"Chen CH, Tang ST. Prognostic disclosure and its influence on cancer patients. J Cancer Res Pract 2014;1:103\u2013112."},{"key":"B9","series-title":"J Pain Symptom Manage","first-page":"121","article-title":"Health information preferences and curability beliefs among patients with advanced cancer","volume":"61","author":"Saracino RM","year":"2021","unstructured":"Saracino RM, Polacek LC, Applebaum AJ,  Health information preferences and curability beliefs among patients with advanced cancer. J Pain Symptom Manage 2021;61:121\u2013127."},{"key":"B10","series-title":"Palliat Med","first-page":"1069","article-title":"Accurate prognostic awareness and preference states influence the concordance between terminally ill cancer patients\u2019 states of preferred and received life-sustaining treatments in the last 6 months of life","volume":"33","author":"Wen FH","year":"2019","unstructured":"Wen FH, Chen JS, Chang WC,  Accurate prognostic awareness and preference states influence the concordance between terminally ill cancer patients\u2019 states of preferred and received life-sustaining treatments in the last 6 months of life. Palliat Med 2019;33:1069\u20131079."},{"key":"B11","series-title":"J Pain Symptom Manage","first-page":"41","article-title":"Preferences for life-sustaining treatments and associations with accurate prognostic awareness and depressive symptoms in terminally ill cancer patients\u2019 last year of life","volume":"51","author":"Tang ST","year":"2016","unstructured":"Tang ST, Wen FH, Hsieh CH,  Preferences for life-sustaining treatments and associations with accurate prognostic awareness and depressive symptoms in terminally ill cancer patients\u2019 last year of life. J Pain Symptom Manage 2016;51:41\u201351.e1."},{"key":"B12","series-title":"JAMA","first-page":"1709","article-title":"Relationship between cancer patients\u2019 predictions of prognosis and their treatment preferences","volume":"279","author":"Weeks JC","year":"1998","unstructured":"Weeks JC, Cook EF, O\u2019Day SJ,  Relationship between cancer patients\u2019 predictions of prognosis and their treatment preferences. JAMA 1998;279:1709\u20131714."},{"key":"B13","series-title":"Patient Educ Couns","first-page":"43","article-title":"Patient centered decision making in palliative cancer treatment: a world of paradoxes","volume":"50","author":"De Haes H","year":"2003","unstructured":"De Haes H, Koedoot N. Patient centered decision making in palliative cancer treatment: a world of paradoxes. Patient Educ Couns 2003;50:43\u201349."},{"key":"B14","series-title":"J Natl Compr Canc Netw","first-page":"997","article-title":"Healthcare cost trajectories in the last 2 years of life among patients with a solid metastatic cancer: a prospective cohort study","volume":"20","author":"Balasubramanian I","year":"2022","unstructured":"Balasubramanian I, Finkelstein E, Malhotra R,  Healthcare cost trajectories in the last 2 years of life among patients with a solid metastatic cancer: a prospective cohort study. J Natl Compr Canc Netw 2022;20:997\u20131004.e3."},{"key":"B15","series-title":"JAMA Oncol","first-page":"778","article-title":"Chemotherapy use, performance status, and quality of life at the end of life","volume":"1","author":"Prigerson HG","year":"2015","unstructured":"Prigerson HG, Bao Y, Shah MA,  Chemotherapy use, performance status, and quality of life at the end of life. JAMA Oncol 2015;1:778\u2013784."},{"key":"B16","series-title":"J Clin Oncol","first-page":"877","article-title":"Prognostic awareness in adult oncology and palliative care","volume":"38","author":"Butow PN","year":"2020","unstructured":"Butow PN, Clayton JM, Epstein RM. Prognostic awareness in adult oncology and palliative care. J Clin Oncol 2020;38:877\u2013884."},{"key":"B17","series-title":"J Clin Oncol","first-page":"915","article-title":"Understanding and addressing the role of coping in palliative care for patients with advanced cancer","volume":"38","author":"Greer JA","year":"2020","unstructured":"Greer JA, Applebaum AJ, Jacobsen JC,  Understanding and addressing the role of coping in palliative care for patients with advanced cancer. J Clin Oncol 2020;38:915\u2013925."},{"key":"B18","series-title":"J Pain Symptom Manage","first-page":"259","article-title":"It is not what you think: associations between perceived cognitive and physical status and prognostic understanding in patients with advanced cancer","volume":"56","author":"Kurita K","year":"2018","unstructured":"Kurita K, Siegler EL, Reid MC,  It is not what you think: associations between perceived cognitive and physical status and prognostic understanding in patients with advanced cancer. J Pain Symptom Manage 2018;56:259\u2013263."},{"key":"B19","series-title":"Support Care Cancer","first-page":"5975","article-title":"Associations of prognostic-awareness-transition patterns with end-of-life care in cancer patients\u2019 last month","volume":"30","author":"Chen CH","year":"2022","unstructured":"Chen CH, Wen FH, Chou WC,  Associations of prognostic-awareness-transition patterns with end-of-life care in cancer patients\u2019 last month. Support Care Cancer 2022;30:5975\u20135989."},{"key":"B20","series-title":"J Palliat Med","first-page":"782","article-title":"Terminally ill cancer patients\u2019 distinct symptom-functional patterns\/states are differentially associated with their accurate prognostic awareness in the last six months of life","volume":"22","author":"Chen JS","year":"2019","unstructured":"Chen JS, Wen FH, Chou WC,  Terminally ill cancer patients\u2019 distinct symptom-functional patterns\/states are differentially associated with their accurate prognostic awareness in the last six months of life. J Palliat Med 2019;22:782\u2013789."},{"key":"B21","series-title":"Oncologist","first-page":"1135","article-title":"Transitions in prognostic awareness among terminally ill cancer patients in their last 6 months of life examined by multi-state Markov modeling","volume":"22","author":"Chen CH","year":"2017","unstructured":"Chen CH, Wen FH, Hou MM,  Transitions in prognostic awareness among terminally ill cancer patients in their last 6 months of life examined by multi-state Markov modeling. Oncologist 2017;22:1135\u20131142."},{"key":"B22","series-title":"Cancer Med","first-page":"4801","article-title":"Prognostic awareness and its association with health outcomes in the last year of life","volume":"12","author":"Ozdemir S","year":"2023","unstructured":"Ozdemir S, Chaudhry I, Ng S,  Prognostic awareness and its association with health outcomes in the last year of life. Cancer Med 2023;12:4801\u20134808."},{"key":"B23","series-title":"J Clin Oncol","first-page":"2319","article-title":"Longitudinal perceptions of prognosis and goals of therapy in patients with metastatic non-small-cell lung cancer: results of a randomized study of early palliative care","volume":"29","author":"Temel JS","year":"2011","unstructured":"Temel JS, Greer JA, Admane S,  Longitudinal perceptions of prognosis and goals of therapy in patients with metastatic non-small-cell lung cancer: results of a randomized study of early palliative care. J Clin Oncol 2011;29:2319\u20132326."},{"key":"B24","series-title":"Psychooncology","first-page":"1449","article-title":"Prognostic awareness in advanced cancer patients and their caregivers: a longitudinal cohort study","volume":"30","author":"Loucka M","year":"2021","unstructured":"Loucka M, Vlckova K, Tuckova A,  Prognostic awareness in advanced cancer patients and their caregivers: a longitudinal cohort study. Psychooncology 2021;30:1449\u20131456."},{"key":"B25","series-title":"Oncologist","first-page":"982","article-title":"Prognostic awareness and discussions of incurability in patients with pretreated non-small cell lung cancer and caregivers: a prospective cohort study","volume":"27","author":"Hasegawa T","year":"2022","unstructured":"Hasegawa T, Okuyama T, Uemura T,  Prognostic awareness and discussions of incurability in patients with pretreated non-small cell lung cancer and caregivers: a prospective cohort study. Oncologist 2022;27:982\u2013990."},{"key":"B26","series-title":"BMC Cancer","first-page":"459","article-title":"Cost of medical care of patients with advanced serious illness in Singapore (COMPASS): prospective cohort study protocol","volume":"18","author":"Teo I","year":"2018","unstructured":"Teo I, Singh R, Malhotra C,  Cost of medical care of patients with advanced serious illness in Singapore (COMPASS): prospective cohort study protocol. BMC Cancer 2018;18:459."},{"key":"B27","series-title":"BMC Med","first-page":"313","article-title":"Longitudinal patterns and predictors of healthcare utilization among cancer patients on home-based palliative care in Singapore: a group-based multi-trajectory analysis","volume":"20","author":"Zhuang Q","year":"2022","unstructured":"Zhuang Q, Chong PH, Ong WS,  Longitudinal patterns and predictors of healthcare utilization among cancer patients on home-based palliative care in Singapore: a group-based multi-trajectory analysis. BMC Med 2022;20:313."},{"key":"B28","series-title":"N Engl J Med","first-page":"1616","article-title":"Patients\u2019 expectations about effects of chemotherapy for advanced cancer","volume":"367","author":"Weeks JC","year":"2012","unstructured":"Weeks JC, Catalano PJ, Cronin A,  Patients\u2019 expectations about effects of chemotherapy for advanced cancer. N Engl J Med 2012;367:1616\u20131625."},{"key":"B29","series-title":"J Pain Symptom Manage","first-page":"23","article-title":"Reliability and validity of the Functional Assessment of Chronic Illness Therapy-Palliative care (FACIT-Pal) scale","volume":"37","author":"Lyons KD","year":"2009","unstructured":"Lyons KD, Bakitas M, Hegel MT,  Reliability and validity of the Functional Assessment of Chronic Illness Therapy-Palliative care (FACIT-Pal) scale. J Pain Symptom Manage 2009;37:23\u201332."},{"key":"B30","series-title":"J Clin Oncol","first-page":"570","article-title":"The Functional Assessment of Cancer Therapy scale: development and validation of the general measure","volume":"11","author":"Cella DF","year":"1993","unstructured":"Cella DF, Tulsky DS, Gray G,  The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. J Clin Oncol 1993;11:570\u2013579."},{"key":"B31","series-title":"Am J Hosp Palliat Care","first-page":"433","article-title":"Association between the timing of goals-of-care discussion and hospitalization outcomes in patients with metastatic cancer","volume":"37","author":"Emiloju OE","year":"2020","unstructured":"Emiloju OE, Djibo DAM, Ford JG. Association between the timing of goals-of-care discussion and hospitalization outcomes in patients with metastatic cancer. Am J Hosp Palliat Care 2020;37:433\u2013438."},{"key":"B32","series-title":"J Palliat Med","first-page":"673","article-title":"Physicians\u2019 propensity to discuss prognosis is associated with patients\u2019 awareness of prognosis for metastatic cancers","volume":"17","author":"Liu PH","year":"2014","unstructured":"Liu PH, Landrum MB, Weeks JC,  Physicians\u2019 propensity to discuss prognosis is associated with patients\u2019 awareness of prognosis for metastatic cancers. J Palliat Med 2014;17:673\u2013682."},{"key":"B33","series-title":"Palliat Med","first-page":"740","article-title":"Perceptions of prognosis and end-of-life care outcomes in patients with advanced lung and gastrointestinal cancer","volume":"37","author":"Gray TF","year":"2023","unstructured":"Gray TF, Plotke R, Heuer L,  Perceptions of prognosis and end-of-life care outcomes in patients with advanced lung and gastrointestinal cancer. Palliat Med 2023;37:740\u2013748."},{"key":"B34","series-title":"Cancer Med","first-page":"20","article-title":"Accuracy of curability expectations in patients with gastrointestinal cancers","volume":"12","author":"Agarwal R","year":"2023","unstructured":"Agarwal R, Shin P, Knezevic A,  Accuracy of curability expectations in patients with gastrointestinal cancers. Cancer Med 2023;12:20\u201329."},{"key":"B35","series-title":"A Theory of Cognitive Dissonance","author":"Festinger L","year":"1957","unstructured":"Festinger L. A Theory of Cognitive Dissonance. Stanford University Press; 1957."},{"key":"B36","series-title":"J Pain Symptom Manage","first-page":"841","article-title":"Emotional numbness modifies the effect of end-of-life discussions on end-of-life care","volume":"45","author":"Maciejewski PK","year":"2013","unstructured":"Maciejewski PK, Prigerson HG. Emotional numbness modifies the effect of end-of-life discussions on end-of-life care. J Pain Symptom Manage 2013;45:841\u2013847."},{"key":"B37","series-title":"Psychosomatics","first-page":"500","article-title":"Prognostic awareness and the terminally ill","volume":"41","author":"Chochinov HM","year":"2000","unstructured":"Chochinov HM, Tataryn DJ, Wilson KG,  Prognostic awareness and the terminally ill. Psychosomatics 2000;41:500\u2013504."},{"key":"B38","series-title":"Cancer","first-page":"2506","article-title":"Willingness to bear adversity and beliefs about the curability of advanced cancer in older adults","volume":"125","author":"Loh KP","year":"2019","unstructured":"Loh KP, Mohile SG, Epstein RM,  Willingness to bear adversity and beliefs about the curability of advanced cancer in older adults. Cancer 2019;125:2506\u20132513."},{"key":"B39","series-title":"Psychooncology","first-page":"780","article-title":"Hope, bias and survival expectations of advanced cancer patients: a cross-sectional study","volume":"30","author":"Finkelstein EA","year":"2021","unstructured":"Finkelstein EA, Baid D, Cheung YB,  Hope, bias and survival expectations of advanced cancer patients: a cross-sectional study. Psychooncology 2021;30:780\u2013788."},{"key":"B40","series-title":"Front Psychol","first-page":"117","article-title":"Self-deception in terminal patients: belief system at stake","volume":"7","author":"Echarte LE","year":"2016","unstructured":"Echarte LE, Bernacer J, Larrivee D,  Self-deception in terminal patients: belief system at stake. Front Psychol 2016;7:117."},{"key":"B41","series-title":"J Palliat Med","first-page":"894","article-title":"The cultivation of prognostic awareness through the provision of early palliative care in the ambulatory setting: a communication guide","volume":"16","author":"Jackson VA","year":"2013","unstructured":"Jackson VA, Jacobsen J, Greer JA,  The cultivation of prognostic awareness through the provision of early palliative care in the ambulatory setting: a communication guide. J Palliat Med 2013;16:894\u2013900."},{"key":"B42","series-title":"BMJ Support Palliat Care","first-page":"53","article-title":"Prognostic awareness in advanced cancer: an integrative literature review","volume":"11","author":"Mone S","year":"2021","unstructured":"Mone S, Kerr H. Prognostic awareness in advanced cancer: an integrative literature review. BMJ Support Palliat Care 2021;11:53\u201358."},{"key":"B43","series-title":"Ann Oncol","first-page":"39","article-title":"Misunderstanding in cancer patients: why shoot the messenger?","volume":"10","author":"Gattellari M","year":"1999","unstructured":"Gattellari M, Butow PN, Tattersall MHN,  Misunderstanding in cancer patients: why shoot the messenger? Ann Oncol 1999;10:39\u201346."},{"key":"B44","series-title":"N Engl J Med","first-page":"1651","article-title":"Talking with patients about dying","volume":"367","author":"Smith TJ","year":"2012","unstructured":"Smith TJ, Longo DL. Talking with patients about dying. N Engl J Med 2012;367:1651\u20131652."},{"key":"B45","series-title":"J Palliat Med","first-page":"445","article-title":"Development of a prognostic awareness impact scale for patients with advanced cancer","volume":"25","author":"Brenner K","year":"2022","unstructured":"Brenner K, Greer JA, Jackson V,  Development of a prognostic awareness impact scale for patients with advanced cancer. J Palliat Med 2022;25:445\u2013454."}],"container-title":["Journal of the National Comprehensive Cancer Network"],"original-title":[],"link":[{"URL":"https:\/\/jnccn.org\/view\/journals\/jnccn\/21\/10\/article-p1021.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/jnccn.org\/downloadpdf\/journals\/jnccn\/21\/10\/article-p1021.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/jnccn.org\/downloadpdf\/journals\/jnccn\/21\/10\/article-p1021.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,12]],"date-time":"2023-10-12T19:27:09Z","timestamp":1697138829000},"score":1,"resource":{"primary":{"URL":"https:\/\/jnccn.org\/view\/journals\/jnccn\/21\/10\/article-p1021.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10]]},"references-count":45,"journal-issue":{"issue":"10"},"URL":"https:\/\/doi.org\/10.6004\/jnccn.2023.7052","relation":{},"ISSN":["1540-1405","1540-1413"],"issn-type":[{"value":"1540-1405","type":"print"},{"value":"1540-1413","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10]]}}}