Grant Number:	1R01CA303291-01A1 Interpret this number
Primary Investigator:	George, Login
Organization:	Rutgers Biomedical And Health Sciences
Project Title:	Patient Obligation to Fight Poor Prognosis Cancer
Fiscal Year:	2026

Project Summary Too many dying patients receive chemotherapy and other toxic treatments in the final days of life that do more harm than good. We developed a conceptual model that explains why patients consent to disease-directed treatments even when they know that the harms of these treatments probably outweigh the benefits. The model suggests that patients perceive social obligations, wherein they feel that they must consent to disease- directed treatments for the sake of others and put on the appearance of feeling better than they really are. Our pilot data showed striking prevalence of such perceived social obligations among 116 patients with poor prognosis cancer. Moreover, perceived social obligations were cross-sectionally associated with worse patient- reported outcomes. Building on these preliminary findings, this R01 from an Early Stage Investigator proposes to examine prospective associations between perceived social obligations and key outcomes in a cohort of 315 patients with advanced, poor prognosis cancer. Aim 1 will test the hypothesis that higher patient-reported social obligations will be associated with worse patient-reported outcomes at 3-month follow-up, including lower sense of peace regarding cancer, worse emotional struggle with cancer, and poorer end-of-life preparedness. Aim 2 focuses on health-service outcomes. We will test the hypothesis that higher patient-reported social obligations will be associated with higher likelihood of hospitalization during the 12-month follow-up period. Additionally, among patients who die during the follow-up period, we hypothesize that patient-reported social obligations will be associated with receipt of intensive treatments in the final 30 days of life and late or no hospice use. Aim 3 uses mixed methods to describe how social obligations are experienced and how these obligations manifest in interactions with family and with clinicians and at the point-of-care. In-depth interviews will be conducted with patients, family members and clinicians to elicit their experiences with social obligations. Findings from this R01 will provide the strongest insights to date on the role of patient-perceived social obligations in end-of-life outcomes. The proposed work is innovative as it examines a novel risk marker, the results of which could stimulate a new area of research on a key socio-emotional process driving harmful end- of-life treatments. The proposed work is impactful as it could inform novel, more effective solutions for the problem of patients receiving disease-directed treatments even when they might prefer comfort care. Such solutions are urgently needed as improving end-of-life care quality is recognized as a pressing public health priority.





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