title: Gender differences in the evolution of illness understanding among patients with advanced cancer.
abstract: BACKGROUND
  Patient understanding of advanced metastatic disease is central to decisions about care near death. Prior studies have focused on gender differences in communication style rather than on illness understanding.
  
  
  OBJECTIVE
  : To evaluate gender differences in terminal illness acknowledgement (TIA), understanding that the disease is incurable and the advanced stage of the disease. To evaluate gender differences in patients' reports of discussions of life expectancy with oncology providers and its effect on differences in illness understanding.
  
  
  METHODS
  Coping with Cancer 2 patients (N = 68) were interviewed before and after a visit with their oncology providers to discuss scan results.
  
  
  RESULTS
  At the prescan interview, there were no statistically significant gender differences in patient measures of illness understanding. At the postscan interview, women were more likely than men to recognize that their illness was incurable (Adjusted Odds Ratio, [AOR] = 5.29; P = .038), know that their cancer was at an advanced stage (AOR = 6.38; P = .013), and report having had discussions of life expectancy with their oncologist (AOR = 4.77; P = .021). Controlling discussions of life expectancy, women were more likely than men to report that their cancer was at an advanced stage (AOR = 9.53; P = .050). Controlling for gender, discussions of life expectancy were associated with higher rates of TIA (AOR = 4.65; P = .036) and higher rates of understanding that the cancer was incurable (AOR = 4.09; P = .085).
  
  
  CONCLUSIONS
  Due largely to gender differences in communication, women over time have a better understanding of their illness than men. More frequent discussions of life expectancy should enhance illness understanding and reduce gender differences.
authors.affiliation: Center for Psychosocial Epidemiology and Outcomes Research, Boston, Massachusetts, USA.
authors.forename: Kalen
authors.initials: K
authors.lastname: Fletcher
authors.affiliation: Center for Psychosocial Epidemiology and Outcomes Research, Boston, Massachusetts, USA.
authors.forename: Holly G
authors.initials: HG
authors.lastname: Prigerson
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Paulk
authors.affiliation: Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Temel
authors.affiliation: Division of Geriatrics and Palliative Medicine, University of New Mexico, Albuquerque, USA.
authors.forename: Esme
authors.initials: E
authors.lastname: Finlay
authors.affiliation: Division of Geriatrics and Palliative Medicine, University of New Mexico, Albuquerque, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Marr
authors.affiliation: Smilow Cancer Hospital at Yale-New Haven, Connecticut, USA.
authors.forename: Ruth
authors.initials: R
authors.lastname: McCorkle
authors.affiliation: University of Massachusetts Boston, USA.
authors.forename: Lorna
authors.initials: L
authors.lastname: Rivera
authors.affiliation: Pomona Valley Hospital Medical Center, Pomona, California, USA.
authors.forename: Francisco
authors.initials: F
authors.lastname: Munoz
authors.affiliation: Center for Psychosocial Epidemiology and Outcomes Research, Boston, Massachusetts, USA.
authors.forename: Paul K
authors.initials: PK
authors.lastname: Maciejewski
mesh_terms: D000368:Aged; D003142:Communication; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D012727:Sex Characteristics