title: Current status of accurate prognostic awareness in advanced/terminally ill cancer patients: Systematic review and meta-regression analysis.
abstract: No systematic meta-analysis is available on the prevalence of cancer patients' accurate prognostic awareness and differences in accurate prognostic awareness by publication year, region, assessment method, and service received.
  
  
  
  To examine the prevalence of advanced/terminal cancer patients' accurate prognostic awareness and differences in accurate prognostic awareness by publication year, region, assessment method, and service received.
  
  
  
  Systematic review and meta-analysis.
  
  
  
  MEDLINE, Embase, The Cochrane Library, CINAHL, and PsycINFO were systematically searched on accurate prognostic awareness in adult patients with advanced/terminal cancer (1990-2014). Pooled prevalences were calculated for accurate prognostic awareness by a random-effects model. Differences in weighted estimates of accurate prognostic awareness were compared by meta-regression.
  
  
  
  In total, 34 articles were retrieved for systematic review and meta-analysis. At best, only about half of advanced/terminal cancer patients accurately understood their prognosis (49.1%; 95% confidence interval: 42.7%-55.5%; range: 5.4%-85.7%). Accurate prognostic awareness was independent of service received and publication year, but highest in Australia, followed by East Asia, North America, and southern Europe and the United Kingdom (67.7%, 60.7%, 52.8%, and 36.0%, respectively; p = 0.019). Accurate prognostic awareness was higher by clinician assessment than by patient report (63.2% vs 44.5%, p < 0.001).
  
  
  
  Less than half of advanced/terminal cancer patients accurately understood their prognosis, with significant variations by region and assessment method. Healthcare professionals should thoroughly assess advanced/terminal cancer patients' preferences for prognostic information and engage them in prognostic discussion early in the cancer trajectory, thus facilitating their accurate prognostic awareness and the quality of end-of-life care decision-making.
authors: 1 Department of Nursing, University of Kang Ning, Tainan, Taiwan.|2 Graduate Institute of Clinical Medical Science, Chang Gung University, Tao-Yuan, Taiwan.
authors: Chen Hsiu
authors: CH
authors: Chen
authors: 2 Graduate Institute of Clinical Medical Science, Chang Gung University, Tao-Yuan, Taiwan.|3 Department of Nursing, Yuanpei University, Hsinchu, Taiwan.
authors: Su Ching
authors: SC
authors: Kuo
authors: 4 School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.|5 Department of Nursing, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.|6 Division of Hematology-Oncology, Chang Gung Memorial Hospital, Linkou, Tao-Yuan, Taiwan.
authors: Siew Tzuh
authors: ST
authors: Tang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D003657:Decision Making; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000451:nursing* / Q000523:psychology*; D057240:Patient Preference / Q000523:psychology*; D012044:Regression Analysis; D013727:Terminal Care / Q000523:psychology*; D019452:Terminally Ill / Q000523:psychology*; D006113:United Kingdom
keywords: Prognosis; accurate prognostic awareness; awareness; neoplasms