Patient-hematologist discordance in perceived chance of cure in hematologic malignancies: A multicenter study

Cancer. 2020 Mar 15;126(6):1306-1314. doi: 10.1002/cncr.32656. Epub 2019 Dec 6.

Abstract

Background: Ensuring that patients with hematologic malignancies have an accurate understanding of their likelihood of cure is important for informed decision making. In a multicenter, longitudinal study, the authors examined discordance in patients' perception of their chance of cure versus that of their hematologists, whether patient-hematologist discordance changed after a consultation with a hematologist, and factors associated with persistent discordance.

Methods: Before and after consultation with a hematologist, patients were asked about their perceived chance of cure (options were <10%, 10%-19%, and up to 90%-100% in 10% increments, and "do not wish to answer"). Hematologists were asked the same question after consultation. Discordance was defined as a difference in response by 2 levels. The McNemar test was used to compare changes in patient-hematologist prognostic discordance from before to after consultation. A generalized linear mixed model was used to examine associations between factors and postconsultation discordance, adjusting for clustering at the hematologist level.

Results: A total of 209 patients and 46 hematologists from 4 sites were included in the current study. Before consultation, approximately 61% of dyads were discordant, which improved to 50% after consultation (P < .01). On multivariate analysis, lower educational level (<college vs postgraduate: odds ratio [OR], 2.24; 95% CI, 1.02-4.92), higher social support-affection subscale score (1-unit change in score: OR, 1.15; 95% CI, 1.00-1.32), and discordance before consultation (OR, 6.17; 95% CI, 2.99-12.72) were found to be significantly associated with discordance after consultation.

Conclusions: Patient-hematologist concordance in prognostic understanding appears to improve after a hematology consultation, but approximately one-half of patients' views of their prognoses were found to remain discordant with those of their hematologists. Interventions are needed to improve prognostic understanding among patients with hematologic malignancies.

Keywords: discordance; hematologic malignancies; perceived chance of cure; prognostic understanding.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adaptation, Psychological
  • Clinical Decision-Making
  • Consensus*
  • Denial, Psychological
  • Educational Status
  • Female
  • Hematologic Neoplasms / psychology
  • Hematologic Neoplasms / therapy*
  • Hematology / statistics & numerical data*
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Quality of Life
  • Social Support
  • Socioeconomic Factors
  • Surveys and Questionnaires / statistics & numerical data
  • Treatment Outcome