What do oncologists think patients with incurable cancer should be told about their prognosis?

Background

Patients require some understanding of their prognosis to make informed treatment decisions and plans for the future. We aimed to determine the frequency, content and documentation of prognostic discussions between medical oncologists and their patients with advanced cancer.

Methods

We surveyed medical oncologists in Australia and New Zealand on their usual practice of discussing prognosis.

Results

206 medical oncologists and oncology trainees completed the survey (response rate 30%). Respondent characteristics were: median age 40 years (range 27 to 75); male 51%; trainees 22%; and 71% had completed prognosis specific communication training. Respondents reported discussing prognosis with a patient a median of 10 times per month (interquartile range 4 to 15) and 82% were always or usually satisfied with their discussions. 88% reported explaining the cancer is incurable to ‘all’ their patients with incurable cancer, and 84% reported ‘always’ or ‘usually’ providing a quantitative estimate of survival time. The most preferred method of explaining survival time was providing “multiple ranges of time with probabilities, e.g. best-case, typical, worst-case scenarios” (52%). Barriers to discussing expected survival time included ‘family members requesting that prognostic information not be discussed’ (identified by 57% of respondents) and ‘not knowing the expected survival time’ (identified by 46%). 60% of respondents reported always or usually documenting prognostic discussions and the expected survival time in the patient’s medical record, and 49% in their letters to other doctors.

Conclusions

While most oncologists provided their patients with quantitative estimates of expected survival time, only 60% reported documenting prognostic discussions and survival estimates in the medical record. Methods to help oncologists estimate, explain and document survival time are needed to improve patient understanding of prognosis.

Editorial acknowledgement

Clinical trial identification

Legal entity responsible for the study

NHMRC Clinical Trials Centre, The University of Sydney.

Funding

Has not received any funding.

Disclosure

B.E. Kiely: Honoraria: Roche; Consulting, advisory role: Teva, Novartis; Travel, accommodation, expenses: Roche. All other authors have declared no conflicts of interest.