The oncologist | 2021
Caregiver-oncologist prognostic concordance, caregiver mastery, and caregiver psychological health and quality of life.
Abstract
BACKGROUND\nCaregivers of adults with cancer often report a different understanding of the patient s prognosis than the oncologist. We examine the associations of caregiver-oncologist prognostic concordance with caregiver depressive symptoms, distress, and quality of life (QoL). We also explore whether these relationships differed by caregiver environment mastery, an individual s sense of control and effectiveness in managing life situations.\n\n\nMETHODS\nWe used data from a national geriatric assessment cluster-randomized trial (URCC 13070) that recruited patients aged ≥70 with incurable cancer considering any line of cancer treatment at community oncology practices, their caregivers, and their oncologists. At enrollment, caregivers and oncologists estimated the patient s prognosis (0-6 months, 7-12 months, 1-2\u2009years, 2-5\u2009years, and >5\u2009years; identical responses were concordant). Caregivers completed the Ryff s environmental mastery at enrollment. At 4-6\u2009weeks, caregivers completed the Patient Health Questionnaire-2, distress thermometer, and the 12-Item Short-Form Health Survey. We used generalized estimating equations in models adjusted for covariates. We then assessed the moderation effect of caregiver mastery.\n\n\nRESULTS\nOf 411 caregiver-oncologist dyads (meanage=66.5), 369 provided responses and 28% were concordant. Prognostic concordance was associated with greater caregiver depressive symptoms (β=0.30; p=0.04) but not distress or QoL. A significant moderation effect for caregiver depressive symptoms was found between concordance and mastery (p=0.01). Specifically, among caregivers with low mastery (<median), concordance was associated with greater depressive symptoms (β=0.68; p=0.003).\n\n\nCONCLUSIONS\nCaregiver-oncologist prognostic concordance was associated with caregiver depressive symptoms. We found a novel moderating effect of caregiver mastery on the relationship between concordance and caregiver depressive symptoms.\n\n\nIMPLICATIONS FOR PRACTICE\nCaregiver-oncologist prognostic concordance is associated with greater caregiver depressive, particularly those with low caregiver mastery. When discussing prognosis with caregivers, physicians should be aware that prognostic understanding may affect caregiver psychological health and assess their depressive symptoms. In addition, while promoting accurate prognostic understanding, physicians should also identify strengths and build resilience among caregivers.