Supportive Care in Cancer

, Volume 16, Issue 9, pp 1049–1057 | Cite as

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

  • Tracy M. Robinson
  • Stewart C. Alexander
  • Margie Hays
  • Amy S. Jeffreys
  • Maren K. Olsen
  • Keri L. Rodriguez
  • Kathryn I. Pollak
  • Amy P. Abernethy
  • Robert Arnold
  • James A. Tulsky
Original Article

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

Communication Cancer Medical oncology Prognosis Physician–patient relations 

References

  1. 1.
    Bradley EH, Hallemeier AG, Fried TR, Johnson-Hurzeler R, Cherlin EJ, Kasl SV et al (2001) Documentation of discussions about prognosis with terminally ill patients. Am J Med 111:218–23PubMedCrossRefGoogle Scholar
  2. 2.
    Butow PN, Maclean M, Dunn SM, Tattersall MH, Boyer MJ (1997) The dynamics of change: cancer patients’ preferences for information, involvement and support. Ann Oncol 8:857–863PubMedCrossRefGoogle Scholar
  3. 3.
    Butow PN, Dowsett S, Hagerty R, Tattersall MH (2002) Communicating prognosis to patients with metastatic disease: what do they really want to know? Support Care Cancer 10:161–168PubMedCrossRefGoogle Scholar
  4. 4.
    Carver CS (1997) You want to measure coping but your protocol’s too long: consider the brief COPE. Int J Behav Med 4:92–100PubMedCrossRefGoogle Scholar
  5. 5.
    Christakis NA, Lamont EB (2000) Extent and determinants of error in doctors’ prognoses in terminally ill patients: prospective cohort study. BMJ 320:469–472PubMedCrossRefGoogle Scholar
  6. 6.
    Clayton JM, Butow PN, Arnold RM, Tattersall MH (2005) Fostering coping and nurturing hope when discussing the future with terminally ill cancer patients and their caregivers. Cancer 103:1965–1975PubMedCrossRefGoogle Scholar
  7. 7.
    Fallowfield LJ, Jenkins VA, Beveridge HA (2002) Truth may hurt but deceit hurts more: communication in palliative care. Palliat Med 16:297–303PubMedCrossRefGoogle Scholar
  8. 8.
    Fried TR, Bradley EH, Towle VR, Allore H (2002) Understanding the treatment preferences of seriously ill patients. N Engl J Med 346:1061–1066PubMedCrossRefGoogle Scholar
  9. 9.
    Fried TR, Bradley EH, O’Leary J (2003) Prognosis communication in serious illness: perceptions of older patients, caregivers, and clinicians. J Am Geriatr Soc 51:1398–403PubMedCrossRefGoogle Scholar
  10. 10.
    Gattellari M, Butow PN, Tattersall MH, Dunn SM, MacLeod CA (1999) Misunderstanding in cancer patients: why shoot the messenger? Ann Oncol 10:39–46PubMedCrossRefGoogle Scholar
  11. 11.
    Glare P, Virik K, Jones M, Hudson M, Eychmuller S, Simes J et al (2003) A systematic review of physicians’ survival predictions in terminally ill cancer patients. BMJ 327:195PubMedCrossRefGoogle Scholar
  12. 12.
    Gordon EJ, Daugherty CK (2003) ‘Hitting you over the head’: oncologists’ disclosure of prognosis to advanced cancer patients. Bioethics 17:142–168PubMedCrossRefGoogle Scholar
  13. 13.
    Hagerty RG, Butow PN, Ellis PA, Lobb EA, Pendlebury S, Leighl N et al (2004) Cancer patient preferences for communication of prognosis in the metastatic setting. J Clin Oncol 22:1721–1730PubMedCrossRefGoogle Scholar
  14. 14.
    Hagerty RG, Butow PN, Ellis PM, Lobb EA, Pendlebury SC, Leighl N et al (2005) Communicating with realism and hope: incurable cancer patients’ views on the disclosure of prognosis. J Clin Oncol 23:1278–1288PubMedCrossRefGoogle Scholar
  15. 15.
    Haidet P, Hamel MB, Davis RB, Wenger N, Reding D, Kussin PS et al (1998) Outcomes, preferences for resuscitation, and physician–patient communication among patients with metastatic colorectal cancer. SUPPORT Investigators. Study to understand prognoses and preferences for outcomes and risks of treatments. Am J Med 105:222–229PubMedCrossRefGoogle Scholar
  16. 16.
    Helft PR (2005) Necessary collusion: prognostic communication with advanced cancer patients. J Clin Oncol 23:3146–3150PubMedCrossRefGoogle Scholar
  17. 17.
    Jenkins V, Fallowfield L, Saul J (2001) Information needs of patients with cancer: results from a large study in UK cancer centres. Br J Cancer 84:48–51PubMedCrossRefGoogle Scholar
  18. 18.
    Kodish E, Post SG (1995) Oncology and hope. J Clin Oncol 13:1817PubMedGoogle Scholar
  19. 19.
    Koropchak CM, Pollak KI, Arnold R, Alexander SC, Skinner CS, Olsen M et al (2006) Studying communication in oncologist–patient encounters: the SCOPE Trial. Palliat Med 20:813–819PubMedCrossRefGoogle Scholar
  20. 20.
    Lamont EB, Christakis NA (2001) Prognostic disclosure to patients with cancer near the end of life. Ann Intern Med 134:1096–1105PubMedGoogle Scholar
  21. 21.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174PubMedCrossRefGoogle Scholar
  22. 22.
    Lobb EA, Kenny DT, Butow PN, Tattersall MH (2001) Women’s preferences for discussion of prognosis in early breast cancer. Health Expect 4:48–57PubMedCrossRefGoogle Scholar
  23. 23.
    Mackillop WJ, Stewart WE, Ginsburg AD, Stewart SS (1988) Cancer patients’ perceptions of their disease and its treatment. Br J Cancer 58:355–358PubMedGoogle Scholar
  24. 24.
    Mackillop WJ, Quirt CF (1997) Measuring the accuracy of prognostic judgments in oncology. J Clin Epidemiol 50:21–29PubMedCrossRefGoogle Scholar
  25. 25.
    Meropol NJ, Weinfurt KP, Burnett CB, Balshem A, Benson AB 3rd, Castel L (2003) Perceptions of patients and physicians regarding phase I cancer clinical trials: implications for physician–patient communication. J Clin Oncol 21:2589–2596PubMedCrossRefGoogle Scholar
  26. 26.
    Miyaji NT (1993) The power of compassion: truth-telling among American doctors in the care of dying patients. Soc Sci Med 36:249–264PubMedCrossRefGoogle Scholar
  27. 27.
    Parkes CM (1972) Accuracy of predictions of survival in later stages of cancer. Br Med J 2:29–31PubMedCrossRefGoogle Scholar
  28. 28.
    Quirt CF, Mackillop WJ, Ginsburg AD, Sheldon L, Brundage M, Dixon P et al (1997) Do doctors know when their patients don’t? A survey of doctor–patient communication in lung cancer. Lung Cancer 18:1–20PubMedCrossRefGoogle Scholar
  29. 29.
    Rodriguez KL, Gambino FJ, Hagerty R, Butow P, Arnold RM (2007) Pushing up daisies: implicit and explicit language in oncologist–patient communication about death. Support Care Cancer 15:153–161PubMedCrossRefGoogle Scholar
  30. 30.
    Siminoff LA, Fetting JH, Abeloff MD (1989) Doctor–patient communication about breast cancer adjuvant therapy. J Clin Oncol 7:1192–2000PubMedGoogle Scholar
  31. 31.
    The AM, Hak T, Koeter G, van Der Wal G (2000) Collusion in doctor–patient communication about imminent death: an ethnographic study. BMJ 321:1376–1381PubMedCrossRefGoogle Scholar
  32. 32.
    Weeks JC, Cook EF, O’Day SJ, Peterson LM, Wenger N, Reding D et al (1998) Relationship between cancer patients’ predictions of prognosis and their treatment preferences. JAMA 279:1709–1704PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Tracy M. Robinson
    • 1
    • 2
  • Stewart C. Alexander
    • 3
    • 4
    • 5
  • Margie Hays
    • 6
  • Amy S. Jeffreys
    • 3
  • Maren K. Olsen
    • 3
    • 7
  • Keri L. Rodriguez
    • 6
    • 8
  • Kathryn I. Pollak
    • 9
    • 10
  • Amy P. Abernethy
    • 4
    • 5
    • 10
    • 11
  • Robert Arnold
    • 6
    • 12
    • 13
  • James A. Tulsky
    • 3
    • 4
    • 5
    • 14
  1. 1.Duke University School of MedicineDurhamUSA
  2. 2.Department of Internal MedicineVanderbilt University Medical CenterNashvilleUSA
  3. 3.Health Services Research and DevelopmentDurham VA Medical CenterDurhamUSA
  4. 4.Department of MedicineDuke University Medical CenterDurhamUSA
  5. 5.Center for Palliative CareDuke University Medical CenterDurhamUSA
  6. 6.Department of Medicine, Division of General Internal MedicineUniversity of Pittsburgh School of MedicinePittsburghUSA
  7. 7.Department of Biostatistics and BioinformaticsDuke University Medical CenterDurhamUSA
  8. 8.Center for Health Equity Research and PromotionVA Pittsburgh Healthcare SystemPittsburghUSA
  9. 9.Department of Community and Family MedicineDuke University Medical CenterDurhamUSA
  10. 10.Duke Comprehensive Cancer Center, Duke Cancer Prevention, Detection and Control Research ProgramDuke University Medical CenterDurhamUSA
  11. 11.Division of Medical OncologyDuke University Medical CenterDurhamUSA
  12. 12.Institute for Doctor–Patient CommunicationUniversity of Pittsburgh School of MedicinePittsburghUSA
  13. 13.Institute to Enhance Palliative CareUniversity of Pittsburgh School of MedicinePittsburghUSA
  14. 14.Center for Aging and Human DevelopmentDuke University Medical CenterDurhamUSA

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