RPD100 - Determining Patient–Oncologist Cancer Treatment Intent Concordance Using Systematic Screening

Key Message : Systematic screening of illness understanding, including primary treatment goal and curability perception, demonstrated similar findings to non-screening studies. Overall concordance rate with oncologist-documented treatment intent was 50.7%, with accuracy rate of illness understanding being 97% in patients with curable cancer and only 37.6% in patients with incurable cancer.

Abstract:

Background: Accurate illness understanding is a necessary component of goal-concordant care [1, 2]. Systematic screening for illness understanding is an innovative approach that may help identify patients who would benefit the most from support to improve outcomes.

Objectives: The objectives of this study were to determine the extent of agreement between patient-reported and oncologist-documented cancer treatment intent using systematic screening and to explore the association between such agreement and patient characteristics.

Methods: We implemented illness understanding screening for patients who presented to our supportive care center (SCC) using two questions from the Prognosis and Treatment Perception Questionnaire regarding primary treatment goal and curability perception [3]. We compared patients screening responses at their initial SCC consultation visit between July 1st, 2023 and October 1st, 2023 with the oncologist-documented treatment intent in the electronic health record.

Results: The analysis included 300 patients (mean age, 59 years); most were women (56%), were White (80.3%), and had advanced disease (78%). Regarding concordance, 152 (50.7%) patients had concordant treatment intent (cure, n=64; non-cure, n=88), and 148 (49.3%) patients had discordant treatment intent (cure, n=2; non-cure, n=146). 97% (n=64) of patients with oncologist-documented treatment intent of cure (n=66) had a concordant treatment intent, while only 37.6% (n=88) of patients with oncologist-documented treatment intent of non-cure (n=234) had a concordant treatment intent. On multivariable analysis, patients with discordant treatment intent were more likely to be Black (OR=3.13, p=0.02), have a primary cancer site of “other” (mostly melanoma and sarcoma) (OR=2.30, p=0.04), have advanced disease (OR=6.25, p< 0.001), and report lower spiritual pain (OR=0.88, p=0.04).

Conclusion: The rate of illness misunderstanding in advanced cancer patients at our SCC was high and consistent with prior non-screening studies. Future studies may examine how systematic screening, coupled with targeted communication interventions, may improve patients’ illness understanding and delivery of goal-concordant care.

References: 1. Mack, J.W., J.C. Weeks, A.A. Wright, S.D. Block, and H.G. Prigerson. End-of-life discussions, goal attainment, and distress at the end of life: predictors and outcomes of receipt of care consistent with preferences. J Clin Oncol, 2010. 28: p. 1203-8. https://doi.org/10.1200/jco.2009.25.4672.
2. Weeks, J.C., E.F. Cook, S.J. O'Day, et al. Relationship between cancer patients' predictions of prognosis and their treatment preferences. Jama, 1998. 279: p. 1709-14. https://doi.org/10.1001/jama.279.21.1709.
3. El-Jawahri, A., L. Traeger, E.R. Park, et al. Associations among prognostic understanding, quality of life, and mood in patients with advanced cancer. Cancer, 2014. 120: p. 278-85. https://doi.org/10.1002/cncr.28369.