Communicating prognosis in cancer care: a systematic review of the literature

Abstract

Prognosis is an issue that most doctors and patients describe as difficult to discuss and the best way of presenting prognostic information to optimise patient understanding, psychological adjustment and decision-making is uncertain. A systematic review of the literature was conducted with the aim of clarifying the current available knowledge of patient preferences, clinician views and current practice regarding the communication of prognosis. Eleven primary research questions guided organisation of the review findings, which were: patient preferences for prognostic information and preferred style of communicating prognosis; disclosure of prognosis to family members; physicians' views on communication of prognosis; current practice of delivering prognostic information; patient understanding and awareness of prognostic information; cultural differences in preferences and understanding; impact of prognostic information on patient outcomes; and interventions to facilitate prognostic discussion. Predictors of patient preferences for and understanding of prognostic information were also summarised. Studies are summarised under the subcategories according to the participants' disease stage. It was found that the majority of the published research has been conducted in the early stage cancer setting providing mostly descriptive evidence, and there is little evidence of the best method of communicating prognosis or of the impact of prognostic information on patient outcomes.

Psychological aspects of cytogenetic testing of uveal melanoma: preliminary findings and directions for future research

“…6 Furthermore, a recent review identified a need for research into the impact of prognostic information on patients' psychological state. 5 Our preliminary study suggests no long-term adverse psychological effects of prognostic information for uveal melanoma, even when this indicates poor prognosis. This is consistent with evidence of the psychological impact of genetic and other tests that indicate risk of future illness.…”

“…However, our finding is consistent with a recent review that concluded that most patients with early stage cancers of many kinds want prognostic information, although the type and quantity wanted varies between individuals and over time. 5 A further limitation is the small number of patients who were interviewed in depth so, although patients' views were consistently positive in this sample, we cannot exclude the possibility that some patients might be harmed by an adverse prognosis. Future studies could test the generalisability of our findings by using standardised quality of life instruments in larger samples.…”

Negotiating Transitions: Involvement of Critical Care Outreach Teams in End-of-Life Decision Making

“…Therefore, we have to address advance care planning in a different way in this population, including earlier discussions about treatment preferences. 16,17 Furthermore, these issues about receiving treatment inappropriately at the EOL are not limited to people with cancer and pervade many other chronic illness populations such as patients with pulmonary, cardiac, or kidney disease. [18][19][20] This study has shown how much time is spent with patients who subsequently are subject to EOL decisions and LOMT and emphasizes that, although not a widely recognized part of the CCOT/MET role or competencies, 9 dealing with EOL care constitutes a significant aspect of the work of CCOTs.…”

Parents’ perspectives on physician-parent communication near the time of a child’s death in the pediatric intensive care unit*

“…Much research exists on formulating and disclosing prognoses at the end of life, especially in the field of oncology (1,(22)(23)(24)(25)(26)(27)(28). Research suggests that while formulating a prognosis can be difficult, equally difficult is communicating that prognosis to the patient and family.…”