Why many oncologists fail to share accurate prognoses: They care deeply for their patients

Abstract

Although most patients with cancer wish to know their prognosis, oncologists often fail to initiate timely and repeated discussions of prognosis with their patients. This gap, rooted in physicians' deep care and optimism for their patients, may be narrowed by 3 complementary approaches: asking simple questions to open up the discussion, assessing patient preferences, and using prognostic tools that can help with the accuracy of prognoses.

Using Process Indicators to Monitor Documentation of Patient-Centred Variables in an Integrated Oncology and Palliative Care Pathway—Results from a Cluster Randomized Trial

“…Communication about prognosis and treatment gives rise to physician and patient related barriers alike. One thing is the emotional element on the part of physicians, patient and family that is difficult to handle and relates to fostering hope [ 58 ]. Further many physicians experience a psychological discomfort associated with disclosing a poor prognosis and feel they lack the necessary skills to communicate bad news [ 59 ].…”

How to focus our efforts in improving prognostic disclosure in oncology

“…We appreciate the thoughtful and valuable responses to our initial commentary by Abernethy et al in their editorial and by Loh et al in their letter. The former touch on potential methods that oncologists could use to improve their communication skills and the quality of the information delivered, and the latter focus on addressing providers' emotions when they are forced to deliver difficult news.…”

“…Although we acknowledge the potential clinical value of prognostic tools highlighted by Abernethy et al for assisting oncologists in forming an accurate prognosis (recognizing that the rapid advancement of the field ensures a moving target for many such instruments), these do not address perhaps a more fundamental problem: overcoming the considerable “activation energy” to disclose prognoses to patients in the first place. In many circumstances, the prognosis is clear, yet disclosure does not occur.…”

Helping patients to understand terrifying news: Addressing the inner lives of physicians and extending beyond what we know

“…We read with interest the articles by Al‐Samkari and Abernethy et al published in Cancer . Both articles emphasize that prognostic awareness is poor among patients with cancer, and we would add that the same applies to caregivers of these patients .…”