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. RobinsonEmail author
  • 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


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.


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.


Communication Cancer Medical oncology Prognosis Physician–patient relations 



We are indebted to the patients, oncologists, and clinic staff who graciously allowed us to observe their conversations and in so doing made this study possible. This research was supported by a grant from the National Cancer Institute (R01-CA100387) and a Stead Scholarship from Duke University School of Medicine.


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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Tracy M. Robinson
    • 1
    • 2
    Email author
  • 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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