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The Importance of Prognostication: Impact of Prognostic Predictions, Disclosures, Awareness, and Acceptance on Patient Outcomes

Current Treatment Options in Oncology volume 22, Article number: 12 (2021) Cite this article

Opinion Statement

In the advanced cancer setting, patients, families, and clinicians are often confronted with an uncertain future regarding treatment outcomes and survival. Greater certainty on what to expect can enhance decision-making for many personal and healthcare issues. Although 70–90% of patients with advanced cancer desire open and honest prognostic disclosure, a small proportion do not want to know. Approximately half of patients with advanced cancer have an inaccurate understanding of their illness, which could negatively impact their decision-making. In this review, we use a conceptual framework to highlight 5 key steps along the prognostic continuum, including (1) prognostic formulation, (2) prognostic disclosure, (3) prognostic awareness, (4) prognostic acceptance, and (5) prognosis-based decision-making. We shall summarize the impact of prognostic predictions, disclosure, awareness, and acceptance on various patient and caregiver outcomes, such as hope, trust, anxiety, depression, chemotherapy use, and care planning. Based on where the patient is at along the prognostic continuum, we propose 5 different subgroups (avoidance: “I don’t want to know”; discordant, “I never wanted to know”; anxious, “I don’t know what’s happening”; concerned, “I don’t like this”; acceptance, “I know how to plan ahead”). Although prognostication is not necessarily a linear process, recognizing where the patient is at cognitively and emotionally along the prognostic continuum may allow clinicians to provide personalized interventions, such as specialist palliative care and psychology referral, towards personalizing prognostic disclosure, enhancing prognostic awareness, increasing prognostic acceptance, and supporting decision-making and, ultimately, improving patient outcomes.

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Funding

David Hui received grants from Insys and Teva. David Hui is also supported in part by grants from the National Cancer Institute (1R01CA214960-01A1; 1R01CA225701-01A1), the National Institute of Nursing Research (1R21NR016736–01), and the American Cancer Society (MRSG-14-1418-01-CCE).

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Affiliations

  1. Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414 - 1515 Holcombe Blvd, Houston, TX, 77030, USA

    David Hui MD, MSc & Li Mo MD

  2. The Center of Gerontology and Geriatrics, National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China

    Li Mo MD

  3. Department of Medical Oncology, Barretos Cancer Hospital, Barretos, Brazil

    Carlos Eduardo Paiva MD

Authors
  1. David Hui MD, MSc
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  2. Li Mo MD
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  3. Carlos Eduardo Paiva MD
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Correspondence to David Hui MD, MSc.

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Hui, D., Mo, L. & Paiva, C.E. The Importance of Prognostication: Impact of Prognostic Predictions, Disclosures, Awareness, and Acceptance on Patient Outcomes. Curr. Treat. Options in Oncol. 22, 12 (2021). https://doi.org/10.1007/s11864-020-00810-3

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  • DOI: https://doi.org/10.1007/s11864-020-00810-3

Keywords

  • Communication
  • Disclosure
  • Forecasting
  • Neoplasm
  • Outcomes assessment
  • Palliative care
  • Prognosis