Prognostic discussions may improve relationship between oncologists, patients with cancer

Prognostic discussions did not harm relationships between patients with cancer and physicians, and may have strengthened patient-oncologist relationships, according to recent findings.

“Oncologists have been urged to prioritize the sharing of prognostic information in hope of reducing patient misperceptions of prognosis,” Joshua Fenton, MD, MPH, of the department of family and community medicine at the University of California Davis Medical Center, and colleagues wrote. “However, several lines of evidence suggest that oncologists may avoid frank discussions of prognosis out of fear of disrupting the physician-patient relationship.”

The researchers performed a longitudinal cohort study of 265 adults with advanced cancer. All patients had received treatment at community or hospital-based clinics in either Northern California or Western New York. Fenton and colleagues assessed prognostic discussions using transcriptions of audio recordings of clinic visits, coding the discussions using the Prognostic and Treatment Choices scale and a patient survey conducted at 3 months after the visit. The researchers used The Human Connection and the Perceived Efficacy in Patient-Physician Interactions scales to evaluate changes in the strength of patient-physician relationships.

Prognostic discussions did not appear associated with declines in either scale. However, an increase of one unit in the Prognostic and Treatment Choices scale appeared linked with an improved Human Connection Scale at both 2 to 7 days after the visit (parameter estimate, 0.10; 95% CI, –0.02 to 0.23) and 3 months later (parameter estimate, 0.18; 95% CI, 0.02-0.35).

Standardized effect sizes appeared associated with two standard-deviation increases in the Prognostic and Treatment Choices scale at each time point; these were “consistent with small beneficial effects,” the researchers wrote (standardized effect size, 0.14; 95% CI, –0.02 to 0.19 at 2 to 7 days; 0.4; 95% CI, 0.02-0.45 at 3 months). The lower bounds of CIs suggested that prognostic discussion was not likely to have a substantial harmful effect on patient-physician relationships.

“Among patients with advanced cancer, oncologist discussion of patient prognosis during clinical encounters was associated with a small but statistically significant improvement in patients’ ratings of the therapeutic alliance with their physicians, and longitudinal analyses based on patient self-report suggest a substantial detrimental effect of prognostic discussion on the doctor-patient relationship is highly unlikely,” the researchers wrote. “Our results provide reassurance that prognostic discussion need not undermine the therapeutic alliance and, in some circumstances, may even strengthen the relationship between patients and oncologists.” – by Andy Polhamus

Disclosures: The authors report no relevant financial disclosures.