• Robert Gramling, Susan Stanek, Han Paul K J PKJ 5 Maine Medical Center Research Institute , Scarborough, Maine., Paul Duberstein, Tim E Quill, Jennifer S Temel, Stewart C Alexander, Wendy G Anderson, Susan Ladwig, and Sally A Norton.
• 1 Division of Palliative Medicine, Department of Family Medicine, University of Vermont Medical Center , Burlington, Vermont.
• J Palliat Med. 2018 Mar 1; 21 (3): 315-321.

BackgroundPrognostic uncertainty is common in advanced cancer and frequently addressed during palliative care consultation, yet we know little about its impact on quality of life (QOL).ObjectiveWe describe the prevalence and distribution of distress due to prognostic uncertainty among hospitalized patients with advanced cancer before palliative care consultation. We evaluate the association between this type of distress and overall QOL before and after palliative care consultation.DesignObservational cohort study.Setting & ParticipantsHospitalized patients with advanced cancer who receive a palliative care consultation at two geographically distant academic medical centers.MeasurementsAt the time of enrollment, before palliative care consultation, we asked participants: "Over the past two days, how much have you been bothered by uncertainty about what to expect from the course of your illness?" (Not at all/Slightly/Moderately/Quite a Bit/Extremely). We defined responses of "Quite a bit" and "Extremely" to be indicative of substantial distress.ResultsTwo hundred thirty-six participants completed the baseline assessment. Seventy-seven percent reported being at least moderately bothered by prognostic uncertainty and half reported substantial distress. Compared with others, those who were distressed by prognostic uncertainty (118/236) reported poorer overall QOL before palliative care consultation (mean QOL 3.8 out of 10 vs. 5.3 out of 10, p = < 0.001) and greater improvement in QOL following consultation (Adjusted difference in mean QOL change = 1.1; 95% confidence interval = 0.2, 2.0).ConclusionsPrognostic uncertainty is a prevalent source of distress among hospitalized patients with advanced cancer at the time of initial palliative care consultation. Distress from prognostic uncertainty is associated with lower levels of preconsultation QOL and with greater pre-post consultation improvement in the QOL.

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