title: Patient characteristics associated with prognostic awareness: a study of a Canadian palliative care population using the InterRAI palliative care instrument.
abstract: BACKGROUND
  Awareness of their medical prognosis enables terminally ill patients to make decisions on treatments and end-of-life care/planning, and to reach acceptance. Yet, many patients receiving palliative care (PC) are unaware of their prognosis, even when death is imminent and has been discussed with health care providers. A better understanding of patient characteristics associated with prognostic awareness (PA) is needed to develop interventions aimed at improving it.
  
  
  OBJECTIVE
  To identify patient characteristics associated with PA in a PC population.
  
  
  METHODS
  The sample comprised 2090 palliative home care patients in Ontario, Canada, assessed using the interRAI Palliative Care Assessment. Independent variables included sociodemographic, cognitive/physical functioning, mood, psychological well-being, and social support. Using cross-sectional data, an adjusted logistic regression model was developed to identify key patient characteristics associated with PA. A multifaceted definition of PA was assumed and represented dichotomously in the model. Multiple imputation was used to address missing data, generating results similar to the complete case analysis.
  
  
  RESULTS
  The PA was higher in patients with: a shorter prognosis (odds ratio [OR] 2.90, 95% confidence interval [CI] 1.93-4.33), increased hours of informal care (OR 1.71, 95% CI 1.15-2.52), less cognitive impairment (OR 1.61, 95% CI 1.14-2.28), and in patients at peace with life (OR 1.79, 95% CI 1.27-2.53). Site differences were observed but do not reflect differences in age, gender, prognosis, or diagnosis.
  
  
  CONCLUSIONS
  Some patient characteristics are amenable to clinical intervention to raise PA, such as being at peace, cognitive impairment, and depression. Prognostic communications vary in timing and quality and may underlie our site differences, but further research is required to confirm this.
authors.affiliation: Aging and Community Health Research Unit, McMaster University, Hamilton, Ontario, Canada. Electronic address: fisheka@mcmaster.ca.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Fisher
authors.affiliation: Department of Oncology, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Hsien
authors.initials: H
authors.lastname: Seow
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.
authors.forename: Joachim
authors.initials: J
authors.lastname: Cohen
authors.affiliation: LUCAS & Faculty of Social Sciences, University of Leuven, Leuven, Belgium.
authors.forename: Anja
authors.initials: A
authors.lastname: Declercq
authors.affiliation: School of Health Sciences, University of Northern British Columbia, Prince George, British Columbia, Canada.
authors.forename: Shannon
authors.initials: S
authors.lastname: Freeman
authors.affiliation: Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada.
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Guthrie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001364:Awareness; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010166:Palliative Care / Q000379:methods* / Q000523:psychology*; D011379:Prognosis; D055815:Young Adult
keywords: Prognostic awareness; interRAI palliative care assessment; palliative care; predictors of prognostic awareness; psychological well-being