title: Associations among awareness of prognosis, hopefulness, and coping in patients with advanced cancer participating in phase I clinical trials.
abstract: OBJECTIVE
  There is considerable debate concerning prognosis in patients with advanced cancer (advanced cancer patients, ACP), but no one has systematically examined the relationship between awareness of prognosis and hopefulness. In this study, the relationships among awareness of prognosis, hopefulness, and coping were examined in a selected group of ACP.
  
  
  METHODS
  All subjects were enrolled in phase I trials. Information was obtained from subjects via structured, face-to-face interviews. Subjects provided demographic information, answered questions designed to ascertain their awareness of their prognosis, and completed the Functional Assessment of Cancer Therapy-General instrument (FACT-G).
  
  
  RESULTS
  A total of 179 consecutive subjects enrolled in phase I trials were interviewed. Awareness of prognosis was assessed using a semiquantitative scale. Willingness to provide responses to the question was significantly negatively correlated with hopefulness ( r=-0.306, P=0.030). Using items from the FACT-G, hopefulness and coping were positively correlated ( r=0.140, P=0.097). Female subjects were more realistic about their prognosis than men ( b=0.568, P=0.026). More educated patients had higher response rates to the prognosis questions (OR 1.62, P<0.001), and demonstrated a more realistic awareness of prognosis ( b=0.225, P=0.030). Overall, there was a strong association between coping status and responding to the prognosis questions ( P=0.033). Patients who reported being "not at all proud of coping" had a lower response rate than patients who reported better coping.
  
  
  CONCLUSIONS
  Among the ACP who provided responses, many reported an unrealistic view of their prognosis. Having a more accurate view of prognosis in the face of terminal illness was associated with reduced hopefulness, which may be related to a poorer sense of coping. Finally, the prognosis question utilized in the study was problematic, led to a fairly poor response rate, and may be indicative of the many difficulties present in attempting to accurately assess ACPs' perceptions of their prognosis. Other methods, such as in-depth qualitative methods, may lead to more productive inquiry into ACPs' awareness of their prognosis. Further research into the accurate assessment of awareness of prognosis is needed.
authors.affiliation: Department of Medicine, The Regenstrief Institute for Health Care, Indiana University School of Medicine, Indianapolis, Indiana, USA. phelft@iupui.edu
authors.forename: Paul R
authors.initials: PR
authors.lastname: Helft
authors.forename: Fay
authors.initials: F
authors.lastname: Hlubocky
authors.forename: Ming
authors.initials: M
authors.lastname: Wen
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Daugherty
mesh_terms: D000223:Adaptation, Psychological; D001294:Attitude to Health; D001364:Awareness; D017321:Clinical Trials, Phase I as Topic; D003627:Data Interpretation, Statistical; D006801:Humans; D007407:Interviews as Topic; D009369:Neoplasms / Q000523:psychology*; D010361:Patients / Q000523:psychology*