The implementation of a regret-based decision model may help patients with terminal blood cancers attain appropriate end-of-life care, according to research presented at the 2016 ASH Annual Meeting and Exposition.
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“Terminally ill patients are often faced with the decision to forgo potentially life-prolonging treatment or to accept hospice care leading to a peaceful death,” said Benjamin Djulbegovic, MD, PhD, professor of medicine and oncology at University of South Florida and senior member of the departments of hematology and health outcomes and behavior at Moffitt Cancer Center (Tampa, FL). “The decision process in such situations is heavily affected by emotions, chief among them regret. Modern cognitive science increasingly accepts a dual processing approach to human cognition which takes into account both emotion-based and analytical-based cognitive processing.”
Djulbegovic and colleagues constructed a regret-based decision model to help patients decide whether to initiate hospice care or to continue receive treatment with a curative intent. They prospectively validated the model in a cohort of 178 terminally ill adult patients.
The model computed patients’ probability of 6-month survival using a Palliative Performance Score predictive model, which the researchers communicated to patients as a percentage, pictorial, or life expectancy in days. This was followed by eliciting patient preferences regarding current treatment vs palliative care, measured through regret of omission (the failure to accept hospice care) and regret of commission (fear of incurring harms through hospice care or lack of curative treatment).
The researchers used regret of commission and regret of omission data to construct a threshold at which a patient would be indifferent to continuing treatment or accepting hospice care, which was then contrasted against the patients’ survival estimates. These were ultimately compared with the patients’ individual choices. The researchers concluded by asking patients questions pertaining to the utility of the regret model in their decision-making process.
Eighty-five percent of patients (n = 151) agreed with the model’s recommendations for hospice care or continued treatment with a curative intent (P < .000001), and the regret model accurately predicted patient choices in 72% (n = 128) of cases (P < .00001). Nearly all patients (96%; n = 171) reported they were helped by the information provided by the model, and 90% (n = 160) said it influenced their care decisions.
A regression analysis found that nearly 98% of patients inclined to initiate hospice care who were predicted to choose palliative services by the model eventually initiated those services. No other mitigating factors were found to influence patient choice.
“To our knowledge, this is the first formal study in which helping patient clarify their preferences enabled them to make actual choices with a high level of satisfaction,” said Djulbegovic. “We conclude that using the regret model to elicit patient choices is both descriptively and prescriptively valid and can be easily implemented in the actual practice.”
