Journal of General Internal Medicine

, Volume 34, Issue 11, pp 2637–2642 | Cite as

The Stage IV Shuffle: Elusiveness of Straight Talk About Advanced Cancer

  • Donald A. BrandEmail author


During the initial consultation with a patient to communicate a diagnosis of late-stage cancer, the oncologist may refrain from giving survival statistics, redirecting the conversation from the bad news (incurability) to the practical aspects of the patient’s care (treatments, timetables, appointments, and testing to monitor response to treatment). Whether conscious or unconscious, this diversion helps cushion the impact of the disturbing news. This paper shows that clinicians’ gingerly handling of harsh facts when they talk with patients also applies to health educators and researchers when they write about late-stage cancer. As a result, these cancer patients typically lack an understanding of their poor prognosis and the limited effectiveness of most available treatments, possibly compromising their ability to make informed choices. To remedy this problem, I describe an approach to straight talk about late-stage cancer that can give a patient realistic hopes instead of false hopes that are apt to betray later on. I also propose an enhanced method of displaying and interpreting comparative efficacy data that can facilitate understanding and serve as a basis for shared decision making.


cancer communication patient engagement ethics 



I am grateful to Albert B. Lowenfels, MD, Jeffrey T. Berger, MD, and Melissa J. Fazzari, PhD, for their guidance in the formulation of the manuscript, and to Thomas M. Jeitner, PhD, and Allison B. Reiss, MD, for critiquing multiple drafts. I also thank reviewers for their detailed comments, which helped improve the manuscript.

Compliance with Ethical Standards

Conflict of Interest

The author declares that he does not have a conflict of interest.


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  1. 1.NYU Long Island School of MedicineMineolaUSA

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