title: Thinking Forward: Future-oriented Thinking among Patients with Tobacco-associated Thoracic Diseases and Their Surrogates.
abstract: BACKGROUND
  The goal of shared decision making is to match patient preferences, including evaluation of potential future outcomes, with available management options. Yet, it is unknown how patients with smoking-related thoracic diseases or their surrogates display future-oriented thinking.
  
  
  OBJECTIVE
  To document prevalent themes in patients' and potential surrogate decision makers' future-oriented thinking when facing preference-sensitive choices.
  
  
  METHODS
  We conducted 44 scenario-based semistructured interviews among a diverse group of outpatients with smoking-associated thoracic diseases and potential surrogates for whom one of three preference-sensitive decisions would be medically relevant. Using content analysis, we documented prevalent themes to understand how these individuals display future-oriented thinking.
  
  
  RESULTS
  Patients and potential surrogates generally expressed expectations for future outcomes but also acknowledged their limitations in doing so. When thinking about potential outcomes, decision makers relied on past experiences, including those only loosely related; perceived familiarity with treatment options; and spirituality. The content of these expectations included effects on family, emotional predictions, and prognostication. For surrogates, a tension existed between hope-based and fact-based expectations.
  
  
  CONCLUSIONS
  Patients and surrogates may struggle to generate expectations, and these future-oriented thoughts may be based on loosely related past experiences or unrealistic optimism. These tendencies may lead to errors, preventing selection of treatments that promote true preferences. Clinicians should explore how decision makers engage in future-oriented thinking and what their expectations are as a component of the shared decision-making process. Future research should evaluate whether targeted guidance in future-oriented thinking may improve outcomes important to patients.
authors.affiliation: 1 Division of Pulmonary, Allergy, and Critical Care Medicine.|2 Leonard Davis Institute of Health Economics.|3 Fostering Improvement in End-of-Life Decision Science Program.
authors.forename: Joanna L
authors.initials: JL
authors.lastname: Hart
authors.affiliation: 4 Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Emily
authors.initials: E
authors.lastname: Pflug
authors.affiliation: 3 Fostering Improvement in End-of-Life Decision Science Program.|5 Center for Clinical Epidemiology and Biostatistics, and.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Madden
authors.affiliation: 1 Division of Pulmonary, Allergy, and Critical Care Medicine.|2 Leonard Davis Institute of Health Economics.|3 Fostering Improvement in End-of-Life Decision Science Program.|5 Center for Clinical Epidemiology and Biostatistics, and.|6 Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Halpern
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000209:etiology / Q000523:psychology; D017028:Caregivers / Q000523:psychology; D003657:Decision Making; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008175:Lung Neoplasms / Q000209:etiology / Q000523:psychology; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000209:etiology / Q000523:psychology; D012907:Smoking / Q000009:adverse effects* / Q000523:psychology*; D013850:Thinking
keywords: chronic pulmonary disease; non–small cell carcinoma; patient preference; shared decision making; solitary pulmonary nodule