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Accuracy of expected symptoms and subsequent quality of life measures among adults with COPD

JAMA Network Open November 21, 2023

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IMPORTANCE: Patients’ expectations for future health guide their decisions and enable them to prepare, adapt, and cope. However, little is known about how inaccurate expectations may affect patients’ illness outcomes.

OBJECTIVE: To assess the association between patients’ expectation inaccuracies and health-related quality of life.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study of patients with severe chronic obstructive pulmonary disease (COPD) was conducted from 2017 to 2021, which included a 24-month follow-up period. Eligible participants received outpatient primary care at pulmonary clinics of a single large US health system. Data were analyzed between 2021 and 2023.

EXPOSURE: Expectation accuracy, measured by comparing patients’ self-reported expectations of their symptom burden with their actual physical and emotional symptoms 3, 12, and 24 months in the future.

MAIN OUTCOME AND MEASURE: Health-related quality of life, measured by the St George’s Respiratory Questionnaire-COPD at 3, 12, and 24 months.

RESULTS: A total of 207 participants were included (median age, 65.5 years [range, 42.0-86.0 years]; 120 women [58.0%]; 118 Black [57.0%], 79 White [38.2%]). The consent rate among approached patients was 80.0%. Most patients reported no or only limited discussions of future health and symptom burdens with their clinicians. Across physical and emotional symptoms and all 3 time points, patients’ expectations were more optimistic than their experiences. There were no consistent patterns of measured demographic or behavioral characteristics associated with expectation accuracy. Regression models revealed that overoptimistic expectations of future burdens of dyspnea (linear regression estimate, 4.68; 95% CI, 2.68 to 6.68) and negative emotions (linear regression estimate, −3.04; 95% CI, −4.78 to 1.29) were associated with lower health-related quality of life at 3 months after adjustment for baseline health-related quality of life, forced expiratory volume over 1 second, and interval clinical events (P < .001 for both). Similar patterns were observed at 12 months (dyspnea: linear regression estimate, 2.41; 95% CI, 0.45 to 4.37) and 24 months (negative emotions: linear regression estimate, −2.39; 95% CI, −4.67 to 0.12; dyspnea: linear regression estimate, 3.21; 95% CI, 0.82 to 5.60), although there was no statistically significant association between expectation of negative emotions and quality of life at 12 months.

CONCLUSIONS AND RELEVANCE: In this cohort study of patients with COPD, we found that patients are overoptimistic in their expectations about future negative symptom burdens, and such inaccuracies were independently associated with worse well-being over time. Developing and implementing strategies to improve patients’ symptom expectations may improve patient-centered outcomes.


National Institutes of Health


Joanna L Hart, Amy E Summer, Lon Ogunduyile, Folasade C Lapite, David Hong, Casey Whitman, Bryan S Blette, Michael O Harhay, Scott D Halpern