Physicians' propensity to discuss prognosis is associated with patients' awareness of prognosis for metastatic cancers

Abstract

Background: Prognosis discussion is an essential component of informed decision-making. However, many terminally ill patients have a limited awareness of their prognosis and the causes are unclear.

Objective: To explore the impact of physicians' propensity to discuss prognosis on advanced cancer patients' prognosis awareness.

Design: Cancer Care Outcomes Research and Surveillance Consortium (CanCORS) study, a prospective cohort study with patient and physician surveys.

Setting/subjects: We investigated 686 patients with metastatic lung or colorectal cancer at diagnosis who participated in the CanCORS study and reported about their life expectancy. Data were linked to the physician survey from 486 physicians who were identified by these patients as filling important roles in their cancer care.

Results: Few patients with metastatic cancers (16.5%) reported an accurate awareness of their prognosis, defined as reporting a life expectancy of less than 2 years for lung cancer or less than 5 years for colorectal cancer. Patients whose most-important-doctor (in helping patient make decisions) reported discussing prognosis with terminally ill patients earlier were more likely than those whose doctors deferred these discussions to have an accurate prognosis awareness (adjusted proportion, 18.5% versus 7.6%; odds ratio, 3.23; 95% confidence interval, 1.39-7.52; p=0.006).

Conclusions: Few patients with advanced cancer could articulate an accurate prognosis estimate, despite most having received chemotherapy and many physicians reported they would discuss prognosis early. Physicians' propensity to discuss prognosis earlier was associated with more accurate patient reports of prognosis. Enhancing the communication skills of providers with important roles in cancer care may help to improve cancer patients' understanding of their prognosis.

FIG. 1.

Flowchart of the study cohort from Cancer Care Outcomes Research and Surveillance (CanCORS) Database. For each patient, a prespecified hierarchy was used to identify the physician with whom to link based on physician responses from the: (1) most-important-doctor, (2) chemotherapy doctor, (3) primary care physician, and (4) surgeon.

FIG. 2.

Physician response about the timing of prognosis discussion with a terminally ill patient who has 4–6 months to live (n=486).