Discussing prognosis and treatment goals with patients with advanced cancer: A qualitative analysis of oncologists’ language

Abstract

BackgroundThe National Academy of Medicine recommends that cancer patients be knowledgeable of their prognosis to enable them to make informed treatment decisions, but research suggests few patients receive this information.ObjectiveThis qualitative study describes oncologists’ language during discussions of prognosis and treatment goals in clinical interactions with African American patients diagnosed with cancer.DesignWe analysed transcripts from video recordings of clinical interactions between patients with Stage III or IV cancer (n=26) and their oncologists (n=9). In‐depth discourse analysis was conducted to describe and interpret oncologists’ communication behaviours and common linguistic features in the interactions.Setting and participantsData were from a larger study of patient‐provider communication between African Americans and oncologists at two cancer hospitals in Detroit.ResultsPrognosis was discussed in 73.1% (n=19) of the interactions; treatment goals were discussed in 92.3% (n=24). However, analysis revealed that oncologists’ description of prognosis was vague (e.g. “prognosis is a bit worse in your case”) and rarely included a survival estimate. Oncologists often used ambiguous terminology, including euphemisms and jargon, and emphasized uncertainty (e.g. “lesions are suspicious for the disease”). Conversation about prognosis was frequently brief, moving quickly to the urgency and details of treatment.DiscussionThis study demonstrates how oncologists’ language may obscure discussion of prognosis and treatment goals. The identified behaviours may lead to missed opportunities in eliciting and discussing patients’ knowledge about and preferences for their care. Patient‐, provider‐ and system‐oriented interventions are needed to improve clinical communication, especially among minority patients with advanced cancer.

The Doctor–Patient Relationship and Information-Seeking Behavior

“…Cancer communication literature has consistently observed a discrepancy between how patients and their physicians understand various aspects of care. 2,9 Specifically, misunderstanding has been observed regarding the consequences of treatment, 12,13 likelihood of treatment success, 14 patient preferences for care, 15 probability of cure, 16 status (progression) of illness, 16 and likelihood of survival. 2,9 This misapprehension can have drastic consequences, including patients seeking ''futile'' treatments or delaying end-of-life discussions and preparations until too late, as well as adversely affecting patient satisfaction, the patient-physician relationship, and compliance with treatment.…”

“…23 However, these theories cannot account for all instances of misunderstanding, including instances of incomplete disclosure. 2,15,24,25 Although many studies have sought to understand how communication contributes to misunderstanding and how to intervene, 7,9,13,21,26,27 few have evaluated how the patient's relationship with the physician and their perception of the physician's role (and authority) regarding information giving affect the communication and reception of information. Previous research explores how communication builds an effective working relationship 28 and how the physician-patient relationship affects decision-making, 29 health outcomes, 30 and meeting patient's needs and goals.…”

Communicating with patients and families about difficult matters: A rapid review in the context of the COVID-19 pandemic

“…19 Although providing these opportunities does not guarantee a patient or family member will raise illness progression or end of life, there are documented instances where patients take the opportunity to raise these matters. 27,28 Oncology consultations 32,39,60,61 Palliative care 27 Internal medicine 44 Everyday conversations 62 How clinicians seek a patient or family member's perspective about a specific matter All rights reserved. No reuse allowed without permission.…”

Cancer caregivers’ experiences of prognosis in Australia: a qualitative interview study

“…Delivering news about the likely course of illness and mortality risk is a central part of oncology practice and has inspired a large body of clinical literature on communicating (often difficult) information 1 2. Much of this research focuses on how health professionals should communicate about a cancer diagnosis,3 4 while somewhat less attention has been paid to specific interactions around prognosis or clinical forecasting 5 6. Furthermore, most studies exploring prognostic exchanges in therapeutic settings examine patients ’ experiences7–11 versus those of caregivers.…”