• Sean Ng and Semra Ozdemir.
• Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore.
• Palliat Med. 2023 Jun 1; 37 (6): 808823808-823.

BackgroundPrognostic 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.AimTo investigate the associations between prognostic awareness and health-related quality of life outcomes among patients with advanced cancer.DesignThis study was a systematic review, prospectively registered on PROSPERO (CRD42020177228).Data SourcesSeven 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.ResultsWe 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.ConclusionsTo 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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