Examining the Relationship Between Prognostic Awareness, Coping, and End of Life Distress: A Mediation Analysis
Research shows that the majority of patients with advanced cancer demonstrate an inaccurate understanding of their prognosis and that this inaccuracy can lead to unnecessary and unwanted hospital admissions, deaths in acute care settings, late referral to palliative care services, poor symptom control, insufficient end-of-life planning, reduced patient autonomy, and increased end-of-life distress. This is the first study to examine the moderating and mediating effects of neuroticism, death acceptance, and advanced care planning on the relationship between prognostic awareness and end-of-life distress among patients with advanced cancer. Mediation and moderated mediation analyses were used to examine these effects. Results showed that prognostic awareness was significantly associated with poorer outcomes, including higher depressive symptoms and feelings of hopelessness. Death acceptance was identified as a significant mediator of the relationship between prognostic awareness and anxiety and hopelessness. Patients in the aware group demonstrated significantly less acceptance of death than patients in the not-aware group; however, death acceptance was associated with significantly less anxiety symptoms and feelings of hopelessness. Results did not show that advanced care planning was a significant mediator of prognostic awareness and end-of-life distress, although it was significantly associated with prognostic awareness. Patients in the aware group engaged in higher rates of advanced care planning than patients in the not-aware group. Results did not identify any significant moderated mediation effects. These results underscore the complex relationships between prognostic awareness, death acceptance, advanced care planning, and end-of-life distress. Future studies should further determine the moderating and mediating factors that impact the relationship between prognostic awareness and end-of-life distress, in order to better illustrate the conditions in which prognostic awareness can improve end-of-life care.
Duva, Melissa Masterson, "Examining the Relationship Between Prognostic Awareness, Coping, and End of Life Distress: A Mediation Analysis" (2019). ETD Collection for Fordham University. AAI13860634.