SHAPE: Survival expectations and Hope Among Cancer Patients at End-of-Life

Principal Investigator:

Eric A. Finkelstein, Executive Director, Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore

Study Team:

Ravindran Kanesvaran, Lee Lai Heng, Chetna Malhotra, Yin Bun Cheung, Wong Gee Chuan, Toh Chee Keong


The extent to which physicians are conveying prognostic information to late stage cancer patients in Singapore remains an open question. Even if accurately conveyed, the extent to which patients internalize this information is also unknown, nor is it clear which patients would benefit from greater efforts to convey this information. This study aims to address these gaps in efforts to improve the end of life experience for cancer patients in Singapore. We will quantify the hope/belief gap and identify strategies that will allow for tailoring physician-patient communication in efforts to ensure that patients receive the right level of prognostic information consistent with their preferences.


The primary aim of this study is to attempt to discern patient’s beliefs about their prognosis independent of hope. Secondary aims are to explore whether and how patients like to receive prognostic information and the percentage of patients who received the information the way they would have liked, and to identify factors that influence patient’s beliefs about their prognosis.


This is a cross-sectional study of 200 patients with advanced Stage IV solid cancer and/or advanced stage of leukaemia or lymphoma cancer with expected survival of less than one year. Eligible patients are recruited from National Cancer Centre and Singapore General Hospital. Following an informed consent, patients are randomized to receive one of the two sets of the survey questionnaire, which differ in how the prognostic questions are asked. Set A includes prognosis questions similar to those used in prior studies. Set B is identical to Set A but incorporates an incentive compatible strategy where a reward is offered for ‘correct’ answers, as determined by their treating physician’s prediction.

Study sites:

National Cancer Centre Singapore

Singapore General Hospital


The potential large benefit of this study is that this may ultimately lead to improved understanding of patient beliefs, how patients would like to receive prognostic information, and identifying strategies to convey that information as clearly and concisely as possible.


Hope, bias and survival expectations of advanced cancer patients: A cross-sectional study

Finkelstein, E. A., Baid, D., Cheung, Y. B., Schweitzer, M. E., Malhotra, C., Volpp, K., Kanesvaran, R., Lee, L. H., Dent, R. A., Ng Chau Hsien, M., Bin Harunal Rashid, M. F., & Somasundaram, N. (2021). Psycho-oncology, 30(5), 780–788.

Accuracy incentives and framing effects to minimize the influence of cognitive bias among advanced cancer patients

Finkelstein, E. A., Cheung, Y. B., Schweitzer, M. E., Lee, L. H., Kanesvaran, R., & Baid, D. (2021). Journal of health psychology, 13591053211025601. Advance online publication.

Project Start Date:

11 May 2017

Contact Person: