Overoptimistic expectations of future symptoms linked to reduced quality of life in COPD
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Key takeaways:
- Overoptimism of future symptoms was common among patients with COPD.
- Researchers found a link between reduced quality of life and overoptimistic expectations of dyspnea and negative emotions.
Being overoptimistic about future negative emotions and dyspnea was linked to decreased quality of life in patients with COPD, according to results published in JAMA Network Open.
Further, more than half of patients did not discuss expected lifespan or expected emotions with their doctor, according to researchers.
“There have been many efforts to improve communication between physicians and patients, including about prognostic information and understanding patients’ health decisions,” Joanna L. Hart, MD, MSHP, pulmonary and critical care physician at the University of Pennsylvania and assistant professor of pulmonary, allergy and critical care medicine at Perelman School of Medicine, told Healio. “However, our findings show that these efforts have not yet achieved their goal.
“For everyday clinicians, asking about expectations can help patients, family members and clinicians be on the same page about what the future might look like,” she added. “Using ‘best-case’ and ‘worst-case’ scenarios are one way of talking about the future when it feels very uncertain. Doing so might help in the ways we often think of as clinicians: making decisions. But discussions like this can also help patients adjust and cope with their changing health, which may be why overly optimistic expectations are associated with worse quality of life as those patients experience worse-than-expected health and symptom burdens.”
In a prospective cohort study, Hart and colleagues evaluated 207 outpatients (median age, 65.5 years; 58% women; 57% Black; 38.2% white) with COPD to find out how inaccurate expectations of symptom burden impact health-related quality of life using the St. George’s Respiratory Questionnaire-COPD.
At enrollment, patients used the Transition Dyspnea Index (TDI) to report their dyspnea over the prior week and to make projections for 3, 12 and 24 months, completing the TDI again at these time points for comparison. Patients followed the same process for their experiences of 10 emotions using a tool that assesses emotional expectations accuracy.
Data through 24 months were available for only 69.1% of the total cohort due to death, illness, patient withdrawals and loss of patients during follow-up.
When researchers asked patients whether they talked about expected health/emotions with their clinician at baseline, more than half said they did not have discussions about lifespan (82.1%) or emotions (55.6%). Further, discussions on expected physical well-being did not occur for one-third of patients.
“We were surprised by how few patients had spoken with their clinicians about their future health, particularly around lifespan and emotional symptoms, since all these patients have a severe, incurable, debilitating disease,” Hart told Healio.
In terms of expectation accuracy, researchers found that patients had overoptimistic expectations of positive emotions, negative emotions and dyspnea compared with what they experienced, and this viewpoint negatively impacted quality of life.
Specifically, following adjustment for baseline health-related quality of life, FEV1 and interval clinical events, researchers observed reduced health-related quality of life in regression models when patients had overoptimistic expectations of dyspnea burden at 3 months (linear regression estimate, 4.68; 95% CI, 2.68-6.68), 12 months (linear regression estimate, 2.41; 95% CI, 0.45-4.37) and 24 months (linear regression estimate, 3.21; 95% CI, 0.82-5.6).
Patients who expressed overoptimistic expectations of negative emotions also had decreased health-related quality of life at 3 months (linear regression estimate, –3.04; 95% CI, –4.78 to 1.29) and 24 months (linear regression estimate, –2.39; 95% CI, –4.67 to 0.12) in the adjusted regression model. Researchers further found that these patients experienced more depressive symptoms at 3 months and 12 months.
“While we expected optimism, we were surprised to see how consistently overly optimistic expectations were associated with lower quality of life over the time patients were enrolled in the study,” Hart told Healio.
According to Hart, another study on this topic that includes more patients is already underway.
“We are currently enrolling a larger group of patients, along with their caregivers, in a similar study,” Hart told Healio. “While we did an excellent job recruiting a diverse sample into this study, we know COPD affects rural communities and those aren’t well represented here. Our currently enrolling study is drawing from three areas of the U.S., including rural areas and areas where tobacco use remains a major concern. This next study also records the actual visits between patients and their clinicians, allowing us to better understand and develop strategies to improve communication and patients’ understanding of future health.”