title: Informed decision making in advance care planning: concordance of patient self-reported diagnosis with physician diagnosis.
abstract: OBJECTIVE
  This study aimed to determine the extent to which patients with advanced cancer agree with their physicians regarding their cancer diagnoses prior to engaging in advance care planning (ACP) and whether variables such as age and level of education correlate with the degree of patient-physician concordance.
  
  
  METHODS
  One hundred and fifty patients with a diagnosis of cancer and an estimated life expectancy of 18 months or less completed questionnaires about their cancer diagnoses prior to creating an advance directive. A review of the patients' medical records was performed and the physician-designated diagnosis was identified for each patient. Patient-physician agreement on diagnosis was coded based on predetermined study criteria. Concordance rates were expressed in percentages.
  
  
  RESULTS
  The majority of patients (62.2 %) were in exact agreement with their physicians; 24.3 % were in partial agreement with the patient missing part of the diagnosis, and 9.5 % were in partial agreement with the physician missing part of the diagnosis; 4.1 % did not agree with their physicians on diagnosis. Age and education level did not correlate with patient-physician concordance rates.
  
  
  CONCLUSIONS
  The majority of patients with advanced cancer correctly identified their cancer diagnosis. However, almost 40 % were not in full agreement with their physicians regarding diagnosis, a situation that has bearing on efforts to engage in meaningful shared decision making as well as advance care planning.
authors.affiliation: Department of Surgery, College of Medicine, The Pennsylvania State University, 500 University Drive, H151, Hershey, PA 17033, USA. jschubart@hmc.psu.edu
authors.forename: Jane R
authors.initials: JR
authors.lastname: Schubart
authors.forename: Lisa
authors.initials: L
authors.lastname: Toran
authors.forename: Megan
authors.initials: M
authors.lastname: Whitehead
authors.forename: Benjamin H
authors.initials: BH
authors.lastname: Levi
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Green
mesh_terms: D000328:Adult; D032722:Advance Care Planning; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D057286:Electronic Health Records; D006801:Humans; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis*; D010817:Physician-Patient Relations; D011379:Prognosis; D057566:Self Report; D019452:Terminally Ill