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. 2016 Aug;36(6):703-13.
doi: 10.1177/0272989X16638321. Epub 2016 Mar 16.

Factors Affecting Physicians' Intentions to Communicate Personalized Prognostic Information to Cancer Patients at the End of Life: An Experimental Vignette Study

Paul K J Han  1   2 , Nathan F Dieckmann  3   4 , Christina Holt  5 , Caitlin Gutheil  1 , Ellen Peters  1   6
Affiliations

Factors Affecting Physicians' Intentions to Communicate Personalized Prognostic Information to Cancer Patients at the End of Life: An Experimental Vignette Study

Paul K J Han et al. Med Decis Making. 2016 Aug.

Abstract

Purpose: To explore the effects of personalized prognostic information on physicians' intentions to communicate prognosis to cancer patients at the end of life, and to identify factors that moderate these effects.

Methods: A factorial experiment was conducted in which 93 family medicine physicians were presented with a hypothetical vignette depicting an end-stage gastric cancer patient seeking prognostic information. Physicians' intentions to communicate prognosis were assessed before and after provision of personalized prognostic information, while emotional distress of the patient and ambiguity (imprecision) of the prognostic estimate were varied between subjects. General linear models were used to test the effects of personalized prognostic information, patient distress, and ambiguity on prognostic communication intentions, and potential moderating effects of 1) perceived patient distress, 2) perceived credibility of prognostic models, 3) physician numeracy (objective and subjective), and 4) physician aversion to risk and ambiguity.

Results: Provision of personalized prognostic information increased prognostic communication intentions (P < 0.001, η(2) = 0.38), although experimentally manipulated patient distress and prognostic ambiguity had no effects. Greater change in communication intentions was positively associated with higher perceived credibility of prognostic models (P = 0.007, η(2) = 0.10), higher objective numeracy (P = 0.01, η(2) = 0.09), female sex (P = 0.01, η(2) = 0.08), and lower perceived patient distress (P = 0.02, η(2) = 0.07). Intentions to communicate available personalized prognostic information were positively associated with higher perceived credibility of prognostic models (P = 0.02, η(2) = 0.09), higher subjective numeracy (P = 0.02, η(2) = 0.08), and lower ambiguity aversion (P = 0.06, η(2) = 0.04).

Conclusions: Provision of personalized prognostic information increases physicians' prognostic communication intentions to a hypothetical end-stage cancer patient, and situational and physician characteristics moderate this effect. More research is needed to confirm these findings and elucidate the determinants of prognostic communication at the end of life.

Keywords: affect and emotion; numeracy; physician-patient communication; provider decision making; risk communication or risk perception; shared decision making.

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Figures

Figure 1
Figure 1
Experimental design and conditions.
Figure 2
Figure 2
Clinical vignette (alternative experimental text bracketed in bold)
Figure 3a
Figure 3a
Moderators of the influence of prognostic information on prognostic communication intentions: Perceived credibility of prognostic models.
Figure 3b
Figure 3b
Moderators of the influence of prognostic information on prognostic communication intentions: Objective numeracy.
Figure 3c
Figure 3c
Moderators of the influence of prognostic information on prognostic communication intentions: Perceived patient distress.
See this image and copyright information in PMC

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