Supportive Care in Cancer

, Volume 16, Issue 9, pp 1049–1057

Patient–oncologist communication in advanced cancer: predictors of patient perception of prognosis

Authors

    • Duke University School of Medicine
    • Department of Internal MedicineVanderbilt University Medical Center
  • Stewart C. Alexander
    • Health Services Research and DevelopmentDurham VA Medical Center
    • Department of MedicineDuke University Medical Center
    • Center for Palliative CareDuke University Medical Center
  • Margie Hays
    • Department of Medicine, Division of General Internal MedicineUniversity of Pittsburgh School of Medicine
  • Amy S. Jeffreys
    • Health Services Research and DevelopmentDurham VA Medical Center
  • Maren K. Olsen
    • Health Services Research and DevelopmentDurham VA Medical Center
    • Department of Biostatistics and BioinformaticsDuke University Medical Center
  • Keri L. Rodriguez
    • Department of Medicine, Division of General Internal MedicineUniversity of Pittsburgh School of Medicine
    • Center for Health Equity Research and PromotionVA Pittsburgh Healthcare System
  • Kathryn I. Pollak
    • Department of Community and Family MedicineDuke University Medical Center
    • Duke Comprehensive Cancer Center, Duke Cancer Prevention, Detection and Control Research ProgramDuke University Medical Center
  • Amy P. Abernethy
    • Department of MedicineDuke University Medical Center
    • Center for Palliative CareDuke University Medical Center
    • Duke Comprehensive Cancer Center, Duke Cancer Prevention, Detection and Control Research ProgramDuke University Medical Center
    • Division of Medical OncologyDuke University Medical Center
  • Robert Arnold
    • Department of Medicine, Division of General Internal MedicineUniversity of Pittsburgh School of Medicine
    • Institute for Doctor–Patient CommunicationUniversity of Pittsburgh School of Medicine
    • Institute to Enhance Palliative CareUniversity of Pittsburgh School of Medicine
  • James A. Tulsky
    • Health Services Research and DevelopmentDurham VA Medical Center
    • Department of MedicineDuke University Medical Center
    • Center for Palliative CareDuke University Medical Center
    • Center for Aging and Human DevelopmentDuke University Medical Center
Original Article

DOI: 10.1007/s00520-007-0372-2

Cite this article as:
Robinson, T.M., Alexander, S.C., Hays, M. et al. Support Care Cancer (2008) 16: 1049. doi:10.1007/s00520-007-0372-2

Abstract

Goals of work

Advanced cancer patients’ perceptions of prognosis, which are often overly optimistic compared to oncologist estimates, influence treatment preferences. The predictors of patients’ perceptions and the effect of oncologist communication on patient understanding are unclear. This study was designed to identify the communication factors that influence patient–oncologist concordance about chance of cure.

Materials and methods

We analyzed audiorecorded encounters between 51 oncologists and 141 advanced cancer patients with good (n = 69) or poor (n = 72) concordance about chance of cure. Encounters were coded for communication factors that might influence oncologist–patient concordance, including oncologist statements of optimism and pessimism.

Main results

Oncologists made more statements of optimism (mean = 3.3 per encounter) than statements of pessimism (mean = 1.2 per encounter). When oncologists made at least one statement of pessimism, patients were more likely to agree with their oncologist’s estimated chance of cure (OR = 2.59, 95%CI = 1.31–5.12). Statements of optimism and uncertainty were not associated with an increased likelihood that patients would agree or disagree with their oncologists about chance of cure.

Conclusions

Communication of pessimistic information to patients with advanced cancer increases the likelihood that patients will report concordant prognostic estimates. Communication of optimistic information does not have any direct effect. The best communication strategy to maximize patient knowledge for informed decision making while remaining sensitive to patients’ emotional needs may be to emphasize optimistic aspects of prognosis while also consciously and clearly communicating pessimistic aspects of prognosis.

Keywords

CommunicationCancerMedical oncologyPrognosisPhysician–patient relations

Copyright information

© Springer-Verlag 2007