Abstract
Purpose
This study aimed to determine the extent to which patients with advanced cancer agree with their physicians regarding their cancer diagnoses prior to engaging in advance care planning (ACP) and whether variables such as age and level of education correlate with the degree of patient–physician concordance.
Methods
One hundred and fifty patients with a diagnosis of cancer and an estimated life expectancy of 18 months or less completed questionnaires about their cancer diagnoses prior to creating an advance directive. A review of the patients’ medical records was performed and the physician-designated diagnosis was identified for each patient. Patient–physician agreement on diagnosis was coded based on predetermined study criteria. Concordance rates were expressed in percentages.
Results
The majority of patients (62.2 %) were in exact agreement with their physicians; 24.3 % were in partial agreement with the patient missing part of the diagnosis, and 9.5 % were in partial agreement with the physician missing part of the diagnosis; 4.1 % did not agree with their physicians on diagnosis. Age and education level did not correlate with patient–physician concordance rates.
Conclusions
The majority of patients with advanced cancer correctly identified their cancer diagnosis. However, almost 40 % were not in full agreement with their physicians regarding diagnosis, a situation that has bearing on efforts to engage in meaningful shared decision making as well as advance care planning.
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Acknowledgements
The authors acknowledge Elana Farace, Ph.D., Penn State College of Medicine, for her contribution to the conception and design of this research project.
Conflict of interest
The authors (JS, BL, and MG) are faculty at the organization that sponsored the research, one author (MW) is a staff member, and one author (LT) is a medical student. The author (JS) has full control of all primary data and agrees to allow the journal to review the study data if requested. Two of the authors (BL and MG) have intellectual property and copyright interests for the decision aid used for the larger study, Making Your Wishes Known: Planning Your Medical Future (MYWK). To encourage individuals to reflectively and systematically engage in advance care planning regarding end-of-life medical decisions, it is anticipated that MYWK will be made available free of charge for use by the general public, as well as for education purposes.
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Schubart, J.R., Toran, L., Whitehead, M. et al. Informed decision making in advance care planning: concordance of patient self-reported diagnosis with physician diagnosis. Support Care Cancer 21, 637–641 (2013). https://doi.org/10.1007/s00520-012-1654-x
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DOI: https://doi.org/10.1007/s00520-012-1654-x