Relationship Between Cancer Patients' Predictions of Prognosis and Their Treatment Preferences
Jane C. Weeks,E. Francis Cook,Steven J. O'Day,Lynn M. Peterson,Neil S. Wenger,Douglas J. Reding,Frank E. Harrell,Peter S. Kussin,Neal V. Dawson,Alfred F. Connors,Joanne Lynn,Russell S. Phillips +11 more
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Patients with metastatic colon and lung cancer overestimate their survival probabilities and these estimates may influence their preferences about medical therapies, according to patient and physician estimates of the probability of 6-month survival.Abstract:
Context.— Previous studies have documented that cancer patients tend to overestimate the probability of long-term survival. If patient preferences about the trade-offs between the risks and benefits associated with alternative treatment strategies are based on inaccurate perceptions of prognosis, then treatment choices may not reflect each patient’s true values. Objective.— To test the hypothesis that among terminally ill cancer patients an accurate understanding of prognosis is associated with a preference for therapy that focuses on comfort over attempts at life extension. Design.— Prospective cohort study. Setting.—Five teaching hospitals in the United States. Patients.—A total of 917 adults hospitalized with stage III or IV non‐small cell lung cancer or colon cancer metastatic to liver in phases 1 and 2 of the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT). Main Outcome Measures.— Proportion of patients favoring life-extending therapy over therapy focusing on relief of pain and discomfort, patient and physician estimates of the probability of 6-month survival, and actual 6-month survival. Results.— Patients who thought they were going to live for at least 6 months were more likely (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.8-3.7) to favor lifeextending therapy over comfort care compared with patients who thought there was at least a 10% chance that they would not live 6 months. This OR was highest (8.5; 95% CI, 3.0-24.0) among patients who estimated their 6-month survival probability at greater than 90% but whose physicians estimated it at 10% or less. Patients overestimated their chances of surviving 6 months, while physicians estimated prognosis quite accurately. Patients who preferred life-extending therapy were more likely to undergo aggressive treatment, but controlling for known prognostic factors, their 6-month survival was no better. Conclusions.— Patients with metastatic colon and lung cancer overestimate their survival probabilities and these estimates may influence their preferences about medical therapies.read more
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Heuristics and Biases: The Psychology of Intuitive Judgment
TL;DR: In this article, a review is presented of the book "Heuristics and Biases: The Psychology of Intuitive Judgment, edited by Thomas Gilovich, Dale Griffin, and Daniel Kahneman".
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Individual differences in reasoning: Implications for the rationality debate?
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Representativeness revisited: Attribute substitution in intuitive judgment.
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Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment.
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References
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Applied Logistic Regression
David W. Hosmer,Stanley Lemeshow +1 more
TL;DR: Hosmer and Lemeshow as discussed by the authors provide an accessible introduction to the logistic regression model while incorporating advances of the last decade, including a variety of software packages for the analysis of data sets.
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The meaning and use of the area under a receiver operating characteristic (ROC) curve.
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Studies of illness in the aged. the index of adl: a standardized measure of biological and psychosocial function.
TL;DR: The Index of ADL as discussed by the authors was developed to study results of treatment and prognosis in the elderly and chronically ill. Grades of the Index summarize over-all performance in bathing, dressing, going to toilet, transferring, continence, and feeding.
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Measures of association for cross classifications
Leo A. Goodman,William Kruskal +1 more
TL;DR: In this article, a number of alternative measures are considered, almost all based upon a probabilistic model for activity to which the cross-classification may typically lead, and only the case in which the population is completely known is considered, so no question of sampling or measurement error appears.