Prognostic disclosure in cancer care: a systematic literature review

Abstract

Background: Collusion in cancer care is the diplomatic concealment of information between a triad of the health care professional (HCP), patient, and caregiver. Free and expressive communication is determined by multiple factors, which establishes a healthy balance between ‘patient-centric’ and ‘family-centric’ decision making. The lack of a universal approach to prognostic disclosure techniques emphasizes the need for a systematic review of contemporary practice. Methods: A systematic review of the literature was conducted till June 2020 using themes based on cancer, communication, prognostic disclosure, and collusion by using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Fifty-three studies involving 10,569 subjects were studied for their utility on prognostic disclosure using different communication methods and interfaces. Twenty-three studies used a face-to-face interview with subjects while in-person telephonic interviews were conducted in two studies, 16 studies implicated semi-structured questionnaires, and 6 studies mentioned the development of a new technique/tool for disclosure. The duration of a session for prognosis-disclosure ranged from 22 min to 1 h. The involvement of palliative care specialists and mental health professionals was limited during the disclosure of the prognosis. Conclusion: The findings of the review indicate that patients in cancer care are aware of their diagnosis and to a certain extent of prognosis despite nondisclosure by their family members and treating teams. This review emphasizes the assessment of ‘disclosure wishes’ among patients and caregivers in separate interviews rather than simply relying on one specific method of interviewing. The nonconfrontational approach and training among HCPs are of utmost importance to build therapeutic resilience among the treating team involved in cancer care. Since many factors such as family wishes, cultural dissonance, medical model, and patient perception could become barriers to prognostic disclosure, there is a need to develop a universal approach to prognostic disclosure and handling associated collusion.

In‐patient suicide after telephone delivery of bad news to a suspected COVID‐19 patient: What could be done to improve communication quality?

“…Allowing the patient to include their loved ones in remote conversations is crucial, especially if the patient is undergoing isolation and has limited opportunities to connect with others. Given the emotionally challenging nature of receiving a cancer diagnosis virtually while being in isolation, mental health professionals or palliative care specialists should also be involved, if necessary, to assist the patient in navigating through the process [ 1 ].…”

“…Any disclosure of a life‐threatening event, such as a malignancy diagnosis, often causes significant stress to patients. While some patients may respond with acceptance and a determination to fight their illness, research has consistently shown that cancer patients often respond to the disclosure of their diagnosis with a range of negative emotions, such as anxiety, distress, and depression [ 1 , 2 ]. These reactions are often accompanied by feelings of fear, uncertainty, and a sense of loss of control over their lives.…”

Maladaptive coping styles moderate the relationship between information on cancer treatment and psychosocial symptoms: an Italian multicenter study

“…A growing interest in the field of information given to patients with a diagnosis of cancer has spread in the last years ( Wan et al, 2020 ; Sutar and Chaudhary, 2022 ), leading to a consensus on the worldwide importance of cancer diagnosis awareness.…”

Data_Sheet_1.PDF

“…A growing interest in the field of information given to patients with a diagnosis of cancer has spread in the last years (Wan et al, 2020;Sutar and Chaudhary, 2022), leading to a consensus on the worldwide importance of cancer diagnosis awareness.…”