Characteristics of patients with advanced cancer preferring not to know prognosis: a multicenter survey study.

BACKGROUND: For some patients with advanced cancer not knowing prognosis is essential. Yet, in an era of informed decision-making, the potential protective function of unawareness is easily overlooked. We aimed to investigate 1) the proportion of advanced cancer patients preferring not to know prognosis; 2) the reasons underlying patients' prognostic information preference; 3) the characteristics associated with patients' prognostic information preference; and 4) the concordance between physicians' perceived and patients' actual prognostic information preference. METHODS: This is a cross-sectional study with structured surveys (PROSPECT). Medical and thoracic oncologists included patients (n = 524), from seven Dutch hospitals, with metastatic/inoperable cancer and an expected median overall survival of ≤ 12 months. For analysis, descriptive statistics and logistic regression models were used. RESULTS: Twenty-five to 31% of patients preferred not to know a general life expectancy estimate or the 5/2/1-year mortality risk. Compared to patients preferring to know prognosis, patients preferring unawareness more often reported optimism, avoidance and inability to comprehend information as reasons for wanting limited information; and less often reported expectations of others, anxiety, autonomy and a sense of control as reasons for wanting complete information. Females (p < .05), patients receiving a further line of systemic treatment (p < .01) and patients with strong fighting spirit (p < .001) were more likely to prefer not to know prognosis. Concordance between physicians' perceived and patients' actual prognostic information preference was poor (kappa = 0.07). CONCLUSIONS: We encourage physicians to explore patients' prognostic information preferences and the underlying reasons explicitly, enabling individually tailored communication. Future studies may investigate changes in patients' prognostic information preferences over time and examine the impact of prognostic disclosure on patients who prefer unawareness.

Have the Olympic Games become more migratory? A comparative historical perspective.

It is often believed that the Olympic Games have become more migratory. The number of Olympic athletes representing countries in which they weren't born is thought to be on the rise. It should, however, be noted that migration in the context of sports is hardly a new phenomenon. In this paper we hypothesise that, as a reflection of global migration patterns and trends, the number of foreign-born Olympians hasn't necessarily increased in all countries. Furthermore, it was expected that the direction of Olympic migration has changed and that foreign athletes increasingly come from a more diverse palette of countries. We conducted an analysis of approximately 40,000 participants from 11 countries who participated in the Summer Games between 1948 and 2012. The selected countries have different histories of migration and cover the distinction between 'nations of immigrants' (Australia, Canada, United States), 'countries of immigration' (France, Great Britain, Netherlands, Sweden), 'latecomers to immigration' (Italy, Spain) and, what we coin, 'former countries of immigration' (Argentina, Brazil). We conclude that the Olympic Games indeed have not become inherently more migratory. Rather, the direction of Olympic migration has changed and most teams have become more diverse. Olympic migration is thus primarily a reflection of global migration patterns instead of a discontinuity with the past.