title: Predictors of newly diagnosed cancer patients' understanding of the goals of their care at initiation of chemotherapy.
abstract: BACKGROUND
  The American Society of Clinical Oncology Quality Oncology Practice Initiative endorses in their core measures that providers should discuss the goals of care (GOC) at the time of chemotherapy consent. GOC refers to chemotherapy treatment intent: cure versus noncure. In this study, the authors sought to determine whether attributes of patients and initial patient-physician encounters were associated with patients' understanding of their GOC.
  
  
  METHODS
  In total, the authors surveyed 125 consecutive, newly diagnosed patients who were receiving chemotherapy for solid malignancies at a single academic cancer center and performed a medical record review for additional data. Patient understanding of their oncologist's GOC and oncologist's reported GOC were compared. The primary outcome was concordance of patient-physician dyads regarding the GOC (cure vs noncure).
  
  
  RESULTS
  One hundred twenty-five of 137 of eligible patients (91%) completed the survey. Only 95 of 125 patient-physician pairs (75%) patient-physician pairs were concordant regarding the GOC. In a multivariable logistic regression, both older patients (odds ratio, 0.21; 95% confidence interval, 0.08-0.57) and non-native English speakers had an almost 80% lower odds (odds ratio, 0.23; 95% confidence interval, 0.05-0.93) of GOC concordance compared with younger patients and native English speakers. Patients who received printed chemotherapy information during the patient-physician consent process had almost 3 times greater odds (odds ratio, 2.88; 95% confidence interval, 1.24-6.68) of GOC concordance with their physician compared with those who did not receive materials.
  
  
  CONCLUSIONS
  Patient misunderstanding of GOC was substantial, with 25% of cancer patients misunderstanding the goal of their chemotherapy treatment. Key predictors of GOC misunderstanding included factors that potentially were amenable to interventions at the time of chemotherapy consent.
authors.affiliation: Massachusetts General Hospital Cancer Center, Boston, MA 02114, USA. ilennes@partners.org
authors.forename: Inga T
authors.initials: IT
authors.lastname: Lennes
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Temel
authors.forename: Christen
authors.initials: C
authors.lastname: Hoedt
authors.forename: Ashley
authors.initials: A
authors.lastname: Meilleur
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Lamont
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D032882:Comprehension / Q000502:physiology; D005260:Female; D005544:Forecasting; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009369:Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology*; D010347:Patient Care Planning; D012189:Retrospective Studies; D012649:Self Concept; D012959:Socioeconomic Factors
chemical_list: D000970:Antineoplastic Agents