The associations between prognostic awareness and health-related quality of life among patients with advanced cancer: A systematic review.



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Prognostic awareness among patients with advanced cancer is important for better palliative and end-of-life care. However, the relationships between prognostic awareness and patient health-related quality of life outcomes remain inconsistent across studies. Critically synthesizing empirical literature will allow for a better understanding of these associations.


To investigate the associations between prognostic awareness and health-related quality of life outcomes among patients with advanced cancer.


This study was a systematic review, prospectively registered on PROSPERO (CRD42020177228).

Data sources

Seven databases (PubMed/Medline, Embase, Scopus, Cochrane Central, PsycINFO, CINAHL, and Web of Science) were searched in March 2022. Cross-sectional and longitudinal empirical studies in English were included regardless of cancer type or publication date.


We identified 1338 articles and included 36 for review. A substantial proportion of patients remained prognostically unaware (50%). Prognostic awareness was either not significantly associated (48%) or associated with worsened (40%) outcomes. These associations were found to vary (e.g., be differently associated with improved, worsened, or non-significant health-related quality of life outcomes) based on the definition of prognostic awareness used and the population sampled (Asian vs Western). Few structured, validated questionnaires were used and only three studies investigated how the associations evolved over time.


To facilitate better understanding of the relationships between prognostic awareness and health-related quality of life, future research must focus on developing a standardized, "gold standard" measurement of prognostic awareness. Research should also examine the influence of culture and the evolution of these relationships longitudinally.





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Publication Info

Ng, Sean, and Semra Ozdemir (2023). The associations between prognostic awareness and health-related quality of life among patients with advanced cancer: A systematic review. Palliative medicine, 37(6). pp. 808–823. 10.1177/02692163231165325 Retrieved from

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Semra Ozdemir

Associate Professor in Population Health Sciences

Dr. Ozdemir is an Associate Professor in the Department of Population Health Sciences at Duke University and is affiliated with Duke Clinical Research Institute. She also holds a joint appointment at the Signature Programme in Health Services and Systems Research at Duke-NUS Medical School in Singapore. Dr. Ozdemir’s research focuses on three areas of medical decision making: 1) assessing individuals’ preferences and values for healthcare services and products, 2) understanding the medical decision-making process among patients, their family caregivers, and clinicians, and 3) developing decision aids or tools to help individuals make better-informed medical decisions. She uses survey methods, cohort studies, and implementation science principles to conduct research in these areas.

Dr. Ozdemir is an expert in stated-preference methods and shared decision-making tools. Dr. Ozdemir led a large team of health communication and decision science experts and clinicians in the development of an educational and preference-based decision aid for older patients with end-stage kidney disease who are considering dialysis or kidney supportive care. She is an Associate Editor for Value in Health and has served on the editorial boards for Medical Decision Making and Applied Health Economics and Health Policy. She is also the co-chair of the Shared Decision Making Special Interest Group for the Society for Medical Decision Making.

Dr. Ozdemir has a personal interest and commitment to eliminating disparities in making quality medical decisions and promoting diversity stemming from her personal experience, professional career, and many years of living and working in different countries. She loves running, paddling, travelling, and cheering for her sons in their soccer games and bike races.

Areas of expertise: Medical decision making, shared decision making, health preference assessment, stated-preference methods, decision aid research.

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