Trends in Patient Misperception and Decisional Regret During Treatment for Advanced Cancer: An Exploratory, Single-Center Study of English-Speaking Adults

Oncologic patients often misunderstand the benefits and toxicities of palliative-intent therapies. This exploratory, single-center study investigated how these perceptions evolve, their impact on end-of-life (EOL) care quality, and regret. English-speaking adults were surveyed longitudinally about treatment expectations. Patient perceptions were compared to their oncologists’ assessments. Of 119 patients (mean age 65, 61.8% male), 80 (67%) completed at least 1 follow-up survey. Patients’ perceptions of treatment response, symptom palliation, and survival did not become more accurate over time. Perceptions over cure tended to become more accurate, and perceptions of toxicity were consistently accurate. Among deceased participants ( n = 47), 55.1% experienced poor quality EOL care, based on a composite measure of EOL quality. Perception accuracy at baseline was not associated with EOL quality outcomes ( P = .93). Patients with hospice involvement had less accurate perceptions ( P = .03). Twenty-nine patients completed the end-of-treatment survey, none expressed regret. Findings suggest patients’ expectations of treatment do not become more accurate over time. EOL outcomes were not associated with more accurate perceptions. Surviving patients did not regret treatment.