Prognostic awareness and the terminally ill

The authors rated patients who were in advanced stages of cancer and in the ir final few weeks life on their level of awareness of their medical progno sis (N = 200, mean age = 71.0 years. The authors measured prognostic awaren ess with a semistructured interview: dividing patients into those acknowled ging No Awareness, Partial Awareness, and Complete Awareness. The authors a lso administered a semistructured interview for depressive disorders, along with an assessment of various demographic and social support measures. Nin eteen patients (9.5%) denied awareness of both their terminal prognosis and foreshortened life expectancy: Thirty-four patients (17%) were placed in t he partial awareness category): with the remaining 147 patients (73.5%) rep orting complete awareness. Depression was nearly three times greater among patients who did not acknowledge their prognosis, as compared with those wh o demonstrated partial or complete acknowledgment (chi (2) = 7.094), P = 0. 029). In addition to depression, male patients, older patients, and those h aving "intense social contact" were associated with lower ratings of progno stic awareness. Dying patients differ in respect to their capacity to ackno wledge their prognosis. Prognostic disavowal is most likely to arise in pat ients with underlying psychological distress and emotional turmoil.