Characterizing the Nature of Scan Results Discussions: Insights Into Why Patients Misunderstand Their Prognosis

Singh, Sarguni; Cortez, Dagoberto; Maynard, Douglas W.; Cleary, James F.; DuBenske, Lori L.; Campbell, Toby C.

doi:10.1200/jop.2016.014621

Cited by 57 publications

(45 citation statements)

References 45 publications

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“…As Singh and colleagues have noted, many patients with incurable disease have poor “prognosis awareness,” 15 so it is important for the oncologist to have a GoC conversation with the patient to be able to guage the patient’s understanding of the prognosis after a scan that shows progressive disease. Singh and his colleagues reported that of 64 taped oncologist-patient conversations about scan results, only 4 included frank discussions about prognosis.…”

Section: The Goc Templatementioning

confidence: 99%

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Goals-of-care discussions

Saiki

Ferrell

Longo-Schoeberlein

et al. 2017

J Community Support Oncology

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Goals-of-care conversations led by the oncologist are key to advancing the prognostic awareness of the patient and family, but too frequently do not occur or are ineffective in leading to advance care planning and appropriate planning for end-of-life care. At our institution, a phase 3 trial of palliative care added to usual care of phase 1 clinical trial patients gave us the opportunity to develop an electronic medical record–based goals-of-care template for discussions. We can complete all or parts of the form with patients, use it to ensure full coverage of important tasks such as planning for transition to hospice and legacy work, and make sure all the providers are “on the same page” about treatment plans. We have this within our EMR as a SmartPhrase that can be brought up for completion, and have found that it helps to clarify patient understanding. The form can also be used to document advance care planning for both clinical care and billing. Although this tool has not been formally tested, we have found that it is effective in day-to-day practice as well as in research, and we share it here.

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Section: The Goc Templatementioning

confidence: 99%

“…The authors suggested asking the question, “Would you like to talk about what this means?” after showing the patient the scan to allow the patient some control and to get permission to disclose crucial information based on the reading of the scan. 15 …”

Section: The Goc Templatementioning

confidence: 99%

Goals-of-care discussions

Saiki

Ferrell

Longo-Schoeberlein

et al. 2017

J Community Support Oncology

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“…Clinicians often find it difficult to talk about prognosis. Research has shown clinicians sometimes "collude" with patients in creating false optimism, or miss or avoid cues from patients to talk about prognosis, moving straight to talking about treatment options [66,67]. The desire to focus on the positives is understandable, particularly if it is not clear whether patients are ready to talk about their prognosis.…”

Section: Communicating the Prognostic Estimatementioning

confidence: 99%

Prognosticating for Adult Patients With Advanced Incurable Cancer: a Needed Oncologist Skill

Chu

Anderson

White

et al. 2020

Curr. Treat. Options in Oncol.

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Patients with advanced cancer and their families commonly seek information about prognosis to aid decision-making in medical (e.g. surrounding treatment), psychological (e.g. saying goodbye), and social (e.g. getting affairs in order) domains. Oncologists therefore have a responsibility to identify and address these requests by formulating and sensitively communicating information about prognosis. Current evidence suggests that clinician predictions are correlated with actual survival but tend to be overestimations. In an attempt to cultivate prognostic skills, it is recommended that clinicians practice formulating and recording subjective estimates of prognosis in advanced cancer patient's medical notes. When possible, a multi-professional prognostic estimate should be sought as these may be more accurate than individual predictions alone. Clinicians may consider auditing the accuracy of their predictions periodically and using feedback from this process to improve their prognostic skills. Clinicians may also consider using validated prognostic tools to complement their clinical judgements. However, there is currently only limited evidence about the comparative accuracy of different prognostic tools or the extent to which these measures are superior to clinical judgement. Oncologists and palliative care physicians should ensure that they receive adequate training in advanced communication skills, which builds upon their pre-existing skills, to sensitively deliver information on prognosis. In particular, clinicians should acknowledge their own prognostic

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“…In one series of 128 tape-recorded conversations after scan results, only 4 frank discussions of prognosis occurred, even after bad results were given. 11 We as oncologistst know the game has changed in terms of prognosis and options, but our patients do not. We should make it a reflex to ask the question.…”

Section: What In This Study Should Affect Practices At Nci-designatedmentioning

confidence: 99%

Being Critical of Critical Care Given to People With Metastatic Cancer: Get Palliative Care Involved

Mehmood¹,

Smith²

2018

J Natl Compr Canc Netw

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Characterizing the Nature of Scan Results Discussions: Insights Into Why Patients Misunderstand Their Prognosis

Cited by 57 publications

References 45 publications

Goals-of-care discussions

Goals-of-care discussions

Prognosticating for Adult Patients With Advanced Incurable Cancer: a Needed Oncologist Skill

Being Critical of Critical Care Given to People With Metastatic Cancer: Get Palliative Care Involved

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