Perceptions of prognosis and end-of-life care outcomes in patients with advanced lung and gastrointestinal cancer

Background: Many patients with advanced cancer have misperceptions of their prognosis, which may impact end-of-life decision-making. Data regarding associations between prognostic perceptions over time and end-of-life care outcomes are lacking. Aim: To describe patients’ perceptions of their prognosis with advanced cancer and examine associations between these perceptions and end-of-life care outcomes. Design: Secondary analysis of longitudinal data from a randomized controlled trial of a palliative care intervention for patients with newly diagnosed incurable cancer. Setting/Participants: Conducted at an outpatient cancer center in the northeastern United States and patients were within 8 weeks of a diagnosis with incurable lung or non-colorectal gastrointestinal cancer. Results: We enrolled 350 patients in the parent trial, of which 80.5% (281/350) died during the study period. Overall, 59.4% (164/276) of patients reported they were terminally ill, and 66.1% (154/233) reported that their cancer was likely curable at the assessment closest to death. Patient acknowledgment of terminal illness was only associated with lower risk of hospitalizations in the last 30 days of life (OR = 0.52, p = 0.025). Patients who reported their cancer as likely curable were less likely to utilize hospice (OR = 0.25, p = 0.002) or die at home (OR = 0.56, p = 0.043), and they were more likely to be hospitalized in the last 30 days of life (OR = 2.28, p = 0.011). Conclusions: Patients’ perceptions of their prognosis are associated with important end-of-life care outcomes. Interventions are needed to enhance patients’ perceptions of their prognosis and optimize their end-of-life care. </jats:sec

A Marriage Made in Heaven? Mismatches and Misunderstandings between Worker Centres and Unions

Worker centres, community-based mediating institutions that provide support to low-wage workers in the United States, have grown from five in 1992 to 160 in 2007. With unions increasingly targeting low-wage immigrant workers employed in non-footloose industries for organizing drives, it would seem that worker centres and unions are a match made in heaven. On the ground, however, it has been more of a mismatch. This article examines the underlying sources of the mismatch embodied in the structures, ideologies and cultures of worker centres and unions. Copyright Blackwell Publishing Ltd/London School of Economics 2007.

The Creation and Development of an Interest Group: Life at the Intersection of Big Business and Education Reform

Responding to calls from the president of the United Sates and the Business Roundtable, business leaders have become increasingly involved in setting the education reform agenda. Using five interest group theories and longitudinal data; the authors examined the formation, agenda setting, and maintenance of an organization of business leaders. Moderate support was found for each of the theories. Analyses further revealed that policy interests and to a lesser degree, functional interests were important to the formation and activity of the interest group. To forge successful partnerships and to implement effective reform, educators, policy makers, and researchers must better understand the motives and actions that impel business involvement in educationPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66716/2/10.1177_0013161X97033004003.pd