Gina Tuch1, Chandrika Sanapala2, Supriya G Mohile2, Paul R Duberstein3, Enrique Soto-Perez-de-Celis4, Huiwen Xu5, Eva Culakova5, Marie Flannery6, Reza Yousefi-Nooraie7, Ronald M Epstein8,9, Colin McHugh2, Valerie Aarne10, Hannah Kim2, Jodi Geer11, Mark A O'Rourke12, Nicholas J Vogelzang13, Kah Poh Loh2. 1. Department of Aged Care, Alfred Health, Melbourne, Australia. 2. Division of Hematology/Oncology, Department of Medicine, James P Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York, USA. 3. Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA. 4. Department of Geriatrics, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico. 5. Department of Surgery, Cancer Control, University of Rochester Medical Center, Rochester, New York, USA. 6. School of Nursing, University of Rochester Medical Center, Rochester, New York, USA. 7. Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York, USA. 8. Department of Family Medicine, University of Rochester Medical Center, Rochester, New York, USA. 9. Department of Medicine, Palliative Care, University of Rochester Medical Center, Rochester, New York, USA. 10. SCOREboard Advisory Group, University of Rochester Medical Center, Rochester, New York, USA. 11. Metro Minnesota Community Oncology Research Program, St. Louis Park, Minnesota, USA. 12. National Cancer Institute Community Oncology Research Program (NCORP) of the Carolinas (Greenville Health System NCORP), Greenville, South Carolina, USA. 13. Nevada Cancer Research Foundation NCORP, Las Vegas, Nevada, USA.
Abstract
BACKGROUND: Caregiver perceived autonomy support by the oncologist is important for caregiver well-being and may be affected by the patient's survival. We determined the association of caregiver-oncologist discordance in patient's life expectancy estimates with perceived autonomy support over time and whether the association differed by patient survival status. MATERIALS AND METHODS: We used data from a geriatric assessment cluster-randomized trial (URCC 13070) that recruited patients aged at least 70 years with incurable cancer considering or receiving treatment, their caregivers, and their oncologists. At baseline, caregivers and oncologists were asked to estimate patient's life expectancy (0-6 months, 7-12 months, 1-2 years, 2-5 years, and >5 years; any difference in response was considered discordant). At 4-6 weeks, 3 months, and 6 months, caregivers completed the Health Care Climate Questionnaire (HCCQ), which measured perceived autonomy support by the oncologist. Generalized estimating equation modeling was conducted to assess the association of baseline caregiver-oncologist discordance with longitudinal HCCQ scores, stratified by patient 6-month survival status. RESULTS: Discordant life expectancy estimates were present in 72.0% of dyads. In multivariate analyses, caregiver-oncologist discordance in patient's life expectancy estimates was associated with higher caregiver HCCQ scores. In stratified analysis, caregiver-oncologist discordance was associated with lower caregiver HCCQ scores (β = -3.46; 95% CI, -4.64 to -2.29) among patients who died within 6 months but with higher caregiver HCCQ scores (β = 1.33; 95% CI, 0.63-2.04) among patients who survived beyond 6 months. CONCLUSION: Interventions aimed at mitigating discordance need to consider its association with caregiver perceived autonomy support and patient's survival in order to better inform caregiver expectations. IMPLICATIONS FOR PRACTICE: Among patients who died within the first 6 months, caregivers who estimated a different length of life for the patient compared with oncologists were more likely to report lower support from the oncologist, whereas the opposite relationship was seen within patients who survived beyond the first 6 months. When designing interventions to improve caregiver understanding of the patient's prognosis, its relationship with caregiver-perceived support and patient's survival needs to be considered.
BACKGROUND: Caregiver perceived autonomy support by the oncologist is important for caregiver well-being and may be affected by the patient's survival. We determined the association of caregiver-oncologist discordance in patient's life expectancy estimates with perceived autonomy support over time and whether the association differed by patient survival status. MATERIALS AND METHODS: We used data from a geriatric assessment cluster-randomized trial (URCC 13070) that recruited patients aged at least 70 years with incurable cancer considering or receiving treatment, their caregivers, and their oncologists. At baseline, caregivers and oncologists were asked to estimate patient's life expectancy (0-6 months, 7-12 months, 1-2 years, 2-5 years, and >5 years; any difference in response was considered discordant). At 4-6 weeks, 3 months, and 6 months, caregivers completed the Health Care Climate Questionnaire (HCCQ), which measured perceived autonomy support by the oncologist. Generalized estimating equation modeling was conducted to assess the association of baseline caregiver-oncologist discordance with longitudinal HCCQ scores, stratified by patient 6-month survival status. RESULTS: Discordant life expectancy estimates were present in 72.0% of dyads. In multivariate analyses, caregiver-oncologist discordance in patient's life expectancy estimates was associated with higher caregiver HCCQ scores. In stratified analysis, caregiver-oncologist discordance was associated with lower caregiver HCCQ scores (β = -3.46; 95% CI, -4.64 to -2.29) among patients who died within 6 months but with higher caregiver HCCQ scores (β = 1.33; 95% CI, 0.63-2.04) among patients who survived beyond 6 months. CONCLUSION: Interventions aimed at mitigating discordance need to consider its association with caregiver perceived autonomy support and patient's survival in order to better inform caregiver expectations. IMPLICATIONS FOR PRACTICE: Among patients who died within the first 6 months, caregivers who estimated a different length of life for the patient compared with oncologists were more likely to report lower support from the oncologist, whereas the opposite relationship was seen within patients who survived beyond the first 6 months. When designing interventions to improve caregiver understanding of the patient's prognosis, its relationship with caregiver-perceived support and patient's survival needs to be considered.
Authors: Kah Poh Loh; Supriya G Mohile; Ronald M Epstein; Colin McHugh; Marie Flannery; Eva Culakova; Lianlian Lei; Megan Wells; Nikesha Gilmore; Dilip Babu; Mary I Whitehead; William Dale; Arti Hurria; Marsha Wittink; Allison Magnuson; Alison Conlin; Melanie Thomas; Jeffrey Berenberg; Paul R Duberstein Journal: Cancer Date: 2019-03-28 Impact factor: 6.860
Authors: Kirti Malhotra; Joshua J Fenton; Paul R Duberstein; Ronald M Epstein; Guibo Xing; Daniel J Tancredi; Michael Hoerger; Robert Gramling; Richard L Kravitz Journal: Cancer Date: 2019-04-29 Impact factor: 6.860
Authors: Jennifer A Shin; Areej El-Jawahri; Amanda Parkes; Stephen M Schleicher; Helen P Knight; Jennifer S Temel Journal: J Palliat Med Date: 2016-04-28 Impact factor: 2.947
Authors: Arti Hurria; Daneng Li; Kurt Hansen; Sujata Patil; Ravi Gupta; Christian Nelson; Stuart M Lichtman; William P Tew; Paul Hamlin; Enid Zuckerman; Jonathan Gardes; Sewanti Limaye; Mark Lachs; Eva Kelly Journal: J Clin Oncol Date: 2009-08-03 Impact factor: 44.544
Authors: Lisa Jane Mackenzie; Mariko Leanne Carey; Eiji Suzuki; Robert William Sanson-Fisher; Hiromi Asada; Masakazu Ogura; Catherine D'Este; Michio Yoshimura; Masakazu Toi Journal: PLoS One Date: 2018-06-08 Impact factor: 3.240
Authors: Supriya G Mohile; Ronald M Epstein; Arti Hurria; Charles E Heckler; Beverly Canin; Eva Culakova; Paul Duberstein; Nikesha Gilmore; Huiwen Xu; Sandy Plumb; Megan Wells; Lisa M Lowenstein; Marie A Flannery; Michelle Janelsins; Allison Magnuson; Kah Poh Loh; Amber S Kleckner; Karen M Mustian; Judith O Hopkins; Jane Jijun Liu; Jodi Geer; Rita Gorawara-Bhat; Gary R Morrow; William Dale Journal: JAMA Oncol Date: 2020-02-01 Impact factor: 31.777