A new "gold standard" for assessment of prognosis (prog) understanding among advanced @entity5 @entity1 (acp): Narrative interviews of XXXX in phase I trials and invested third party observers (itpo).

@entity5 @entity1 @entity148 @entity221
UNASSIGNED: 8134 Background: Despite @entity221 , prior research shows acp: overestimate survival, provide little acknowledgement (ack) of prog, and have curative care goals. Yet, this research may not accurately reflect prog awareness as it has not accounted for how fear, @entity148 , and hope effect measured responses to queries about when (or if) acp believe they will die. This research has also not included valuable observational experiences of those who bear witness to acp @entity221 experiences. METHODS: Narrative analysis explains effects of emotion on cognitive understanding by seeking descriptions of prior experiences and assessing goal appraisal processes. We studied its use on qualitative interviews of acp and their itpo (spouses/significant others). RESULTS: To date, 28 terminally ill, acp receiving experimental (phase I trial) chemotherapy and 28 itpo have been separately interviewed: 50% male; median age 57 (23-78); 90% married; 96% Caucasian; 57% >high school education; expected median prog: 8 months. Quantitative interview data include, 1.) Likert scores (1-10) of likelihood of chemotherapy in: "halting" @entity5 (mean 7.0, with higher scores among @entity1 acp), producing "remission" (mean 6.4), and (among 30% stating it possible) "curing" (mean 7.1); and, 2.) Scales of affective balance and positive ways of thinking with: itpo with more depressed mood (p<.008), and acp with greater changes in thinking about the value of their life (p<0.1). Narrative analysis reveals that within virtually all acp-itpo interview pairs, there was an ack of a terminal prog-although many did not describe physician disclosure of prog and many acks came outside specific queries about prog understanding. CONCLUSIONS: While-in response to structured queries-acp state both significant expectations of benefit from chemotherapy and inaccurate estimates of survival, narrative analyses of acp and itpo descriptions of @entity221 experiences provide a more accurate portrayal of @entity1 understanding of prog. No significant financial relationships to disclose.
