Career-stage patterns in burnout and intention to leave the current hospital among obstetric physicians.

Older adults with acute myeloid leukemia (AML) face challenges in making treatment decisions due to the sudden onset of disease, potential travel to an unfamiliar medical center to receive final diagnosis, and the need to begin treatment quickly. Patients may feel shocked by their diagnosis, uncertain of their options, and have difficulty processing information presented by their oncologist. Whether older adults with AML understand their prognosis is particularly important in the context of treatment decisions, given their greater risk for treatment-related toxicities and worse survival outcomes relative to younger adults., , , Unfortunately, patient understanding of chance for survival or cure (prognostic understanding/concordance) is often poor, with at least half of the patients with AML having different expectations from their oncologist. Beyond survival, an important but sometimes overlooked aspect of prognosis is functional prognosis, for example how patients can expect their ability to complete daily activities will change in response to their disease and treatment. This is particularly salient for older adults with cancer, most of whom prioritize quality of life and physical function over survival when making decisions about their cancer care., , , Although regulatory bodies such as the US Food and Drug Administration now recommend including patient reported outcomes including physical function in clinical trials of cancer treatments, historically this was rare, which may make communicating functional prognosis challenging for both patients and oncologists. Functional prognosis may be especially important for older adults with AML who are at high risk for rapid (although potentially short term) declines in function related to chemotherapy and stem cell transplant. Mobility-related physical function (eg, standing, walking) is a clinically relevant aspect of function which is feasible to assess and modifiable in many cases, as well as representing a “sentinel” decline that occurs at relatively younger ages and often precedes need for assistance with self-care tasks., , , Changes in mobility are also a patient-centered outcome closely tied to ability to stay in one’s own home throughout the aging process, or “age in place,” an important aging-related goal for most older adults in the United States. Unfortunately, most older adults do not have a plan for increased services and supports to remain in (or return to) their homes in the event of a functional decline. Understanding their functional prognosis may allow older adults to proactively build these valued plans. Overall, there is a need to understand and optimize communication about functional prognosis between older adults with AML and their oncologists. There is a lack of evidence regarding patient and oncologist expectations of functional prognosis among older adults with cancer, which may be of particular importance for older adults with AML at risk for functional decline. To our knowledge, there are no studies which compare patient and oncologist expectations of physical function, which may have significant implications for treatment decision-making. We address this gap using data from older adults with AML participating in a randomized clinical trial of a communication support tool. Our primary objective was to describe patient and oncologist expectations about functional prognosis, and secondary objectives were to estimate the agreement between patient and oncologist expectations and explore differences by study arm.