title: Life and treatment goals of patients with advanced, incurable cancer.
abstract: Goals of care conversations have been suggested as a strategy for helping patients with advanced cancer manage the uncertainty and distress associated with end-of-life care. However, knowledge deficits about patient goals limit the utility of such conversations. We described the life and treatment goals of patients with incurable cancers, including goal values and expectancies. We examined the associations between paramount goals and patient prognosis, performance status, and psychological adjustment.
  
  
  
  Patients with advanced lung cancer, gastrointestinal cancer, or melanoma (N = 84) completed measures of prognosis for 12-month survival, hope, optimism, depression, and anxiety. Oncologists provided patient performance status and prognosis for 12-month survival. We conducted interviews with a subset of patients (N = 63), eliciting life and treatment goals, values, and expectancies.
  
  
  
  Patient life goals resembled goals among healthy populations; whereas, treatment goals were perceived as separate and more important. Cure and fight cancer emerged as the most important goals. Patients who valued cure the most had worse performance status (M = 1.46 vs. 0.78) and more depressive symptoms (M = 6.30 vs. 3.50). Patients who valued fight cancer the most had worse self-prognosis (M = 69.23 % vs. 86.11 %), fewer treatment goals (M = 2.08 vs. 3.16), and lower optimism (M = 15.00 vs. 18.32).
  
  
  
  Patients with advanced cancer perceive treatment goals as separate from and more important than life goals. They hold optimistic expectancies for achieving their goals and for survival. Valuing cure highly may put patients at risk for experiencing psychological maladjustment.
authors: Department of Psychology, Indiana University-Purdue University, 402 North Blackford St., LD 124, Indianapolis, IN, 46202, USA. klrand@iupui.edu.|Indiana University Simon Cancer Center, Indianapolis, IN, USA. klrand@iupui.edu.|Walther Program in Palliative Care Research, Indianapolis, IN, USA. klrand@iupui.edu.|Research in Palliative and End-of-Life Communication and Training Center, Indianapolis, IN, USA. klrand@iupui.edu.
authors: Kevin L
authors: KL
authors: Rand
authors: Department of Psychology, Indiana University-Purdue University, 402 North Blackford St., LD 124, Indianapolis, IN, 46202, USA.
authors: Daniella A
authors: DA
authors: Banno
authors: Department of Psychology, Indiana University-Purdue University, 402 North Blackford St., LD 124, Indianapolis, IN, 46202, USA.
authors: Amanda M
authors: AM
authors: Shea
authors: School of Medicine, Indiana University, Indianapolis, IN, USA.|Indiana University Simon Cancer Center, Indianapolis, IN, USA.|Walther Program in Palliative Care Research, Indianapolis, IN, USA.|Research in Palliative and End-of-Life Communication and Training Center, Indianapolis, IN, USA.
authors: Larry D
authors: LD
authors: Cripe
mesh_terms: D005260:Female; D006040:Goals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality*; D011379:Prognosis; D013727:Terminal Care / Q000523:psychology*; D016896:Treatment Outcome
keywords: Advanced cancer; End-of-life care; Life goals; Self-regulation theory; Treatment goals