Prior research among seriously ill hospitalized patients (SUPPORT project) found that patients' self-estimates of survival were inaccurate compared to actual survival. Most often, patients' prognostic predictions are unrealistically hopeful which complicates end of life decision making. Research studies to understand these patient inaccuracies are lacking and may be informed by understanding patients' tendencies to seek prognostic information. Miller (1987) has researched two parallel information processing styles: monitoring (M), seeking and attending to information or threatening cues, and blunting (B), avoiding such information or cues. Patients with high M scores have had more worry and self-blame about health, have suffered more side effects with chemotherapy, and may be more demanding of physicians. We hypothesize that there may be important relationships among patients' prognostic estimates, mood states (anxiety and depression), and their information processing styles.

Baseline data on demographics, mood, and M&B were collected as part of an ongoing randomized trial of an end-of-life coping and communication intervention among 119 patients with advanced cancer. Sample characteristics: mean age = 62.6 (9.5 SD) years, 72% male, 51% married, median income = $15-19,000, mean education = 12.4 (2.5) years; 57% white, 39.7% African-American, 2.8% other race/ethnicity. Using logistic regression, anxiety and depression were tested for associations with ordinal prognostic estimates after controlling for age, sex, marital status, income, education, functional status, and M&B as main effects. M&B subgroup membership was also entered into the logistic model as dummy variables: high (H) and low (L) levels of M&B defined as HM/HB (n=19), LM/LB (n=56), HM/LB (n=22), LM/HB (n=22).

Higher scores for both depression and anxiety were seen among patients who scored above the median on monitoring. In the logistic model, higher depression but not anxiety scores were significantly associated with lower self-estimates of survival. Membership in the HM/LB subgroup was significantly associated with survival estimates although the subgroup analyses may be unstable due to small sample sizes in the M&B subgroups. Relationships will be re-tested as the sample size increases to examine whether subgroups of coping style are related to differing levels of mood and whether these subgroups are associated with self-estimated prognosis. Analyses on the larger sample will evaluate whether prognostic information may need to be tailored to an individual patient's information processing style.