Patient-reported discordance between care goals and treatment intent in advanced cancer

IF 5.1 2区医学 Q1 ONCOLOGY

Cancer Pub Date : 2025-08-25 DOI:10.1002/cncr.35976

Manan P. Shah MD, Neil S. Wenger MD, MPH, John Glaspy MD, MPH, Ron D. Hays PhD, Rebecca L. Sudore MD, Maryam Rahimi MD, Lisa Gibbs MD, Sidharth Anand MD, MBA, Chi-Hong Tseng PhD, Anne M. Walling MD, PhD

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Abstract

Purpose

Goal-concordant care is achieved when treatment is aligned with goals. This study describes patient-reported concordance between care goals and treatment intent in advanced cancer compared to other serious illnesses.

Methods

A post hoc cross-sectional analysis of baseline survey responses was conducted in adult patients enrolled in a multisite trial of advance care planning. Patients reported whether they prefer and whether they are receiving treatment that prioritizes longevity (life-extending care) versus comfort (comfort-focused care). Concordance between care preferences and perceived treatment intent in patients with advanced cancer versus other advanced illnesses was compared. Mortality rates for patients with cancer stratified by perceived care concordance are reported.

Results

Among 1099 patients, those with advanced cancer (n = 231) reported similar preference for comfort-focused care (49% vs 48%, p = .47) and had similar 24-month mortality (16% v 13%, p = .25) as patients with other serious illnesses (n = 868). Among patients preferring comfort-focused care, patients with cancer (n = 113) were more likely than patients with other illnesses (n = 413) to report receiving (discordant) life-extending care (37% vs. 19%, p < .001). Among patients with cancer preferring comfort-focused care, there was no statistically significant difference in 24-month mortality between those who reported receiving (discordant) life-extending versus (concordant) comfort-focused care (24% v 15%, p = .31).

Conclusion

Compared to patients with other serious illnesses, a relatively large portion of patients with advanced cancer reported that their treatment discordantly focused on longevity over comfort despite their goal to prioritize comfort over longevity.

Abstract Image

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晚期癌症患者报告的护理目标和治疗意图不一致

目的目标-当治疗与目标一致时，实现和谐护理。本研究描述了与其他严重疾病相比，晚期癌症患者报告的护理目标和治疗意图之间的一致性。方法对参加预先护理计划的多地点试验的成年患者进行基线调查反应的事后横断面分析。患者报告他们是否更喜欢以及他们是否正在接受优先考虑长寿（延长生命的护理）和舒适（以舒适为重点的护理）的治疗。比较晚期癌症患者与其他晚期疾病患者的护理偏好和感知治疗意图之间的一致性。死亡率的癌症患者分层感知护理的一致性报告。结果在1099例患者中，晚期癌症患者（n = 231）与其他严重疾病患者（n = 868）对舒适护理的偏好相似（49% vs 48%, p = 0.47）， 24个月死亡率相似（16% vs 13%, p = 0.25）。在喜欢舒适护理的患者中，癌症患者（n = 113）比其他疾病患者（n = 413）更有可能接受（不一致的）延长生命护理（37% vs. 19%, p < .001）。在偏爱舒适护理的癌症患者中，接受（不一致）延长生命治疗与接受（一致）舒适护理的患者24个月死亡率无统计学差异（24% vs 15%, p = 0.31）。与其他严重疾病的患者相比，相对较大比例的晚期癌症患者报告说，尽管他们的目标是优先考虑舒适而不是长寿，但他们的治疗不一致地关注长寿而不是舒适。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cancer 医学-肿瘤学

CiteScore

13.10

自引率

3.20%

发文量

480

审稿时长

2-3 weeks

期刊介绍： The CANCER site is a full-text, electronic implementation of CANCER, an Interdisciplinary International Journal of the American Cancer Society, and CANCER CYTOPATHOLOGY, a Journal of the American Cancer Society. CANCER publishes interdisciplinary oncologic information according to, but not limited to, the following disease sites and disciplines: blood/bone marrow; breast disease; endocrine disorders; epidemiology; gastrointestinal tract; genitourinary disease; gynecologic oncology; head and neck disease; hepatobiliary tract; integrated medicine; lung disease; medical oncology; neuro-oncology; pathology radiation oncology; translational research