Prognostic disclosure in oncology - current communication models: a scoping review

Abstract

BackgroundPrognostic disclosure is essential to informed decision making in oncology, yet many oncologists are unsure how to successfully facilitate this discussion. This scoping review determines what prognostic communication models exist, compares and contrasts these models, and explores the supporting evidence.MethodA protocol was created for this study using the Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols extension for Scoping Reviews. Comprehensive literature searches of electronic databases MEDLINE, EMBASE, PsycINFO and Cochrane CENTRAL were executed to identify relevant publications between 1971 and 2020.ResultsIn total, 1532 articles were identified, of which 78 met inclusion criteria and contained 5 communication models. Three of these have been validated in randomised controlled trials (the Serious Illness Conversation Guide, the Four Habits Model and the ADAPT acronym) and have demonstrated improved objective communication measures and patient reported outcomes. All three models emphasise the importance of exploring patients’ illness understanding and treatment preferences, communicating prognosis and responding to emotion.ConclusionCommunicating prognostic estimates is a core competency skill in advanced cancer care. This scoping review highlights available communication models and identifies areas in need of further assessment. Such areas include how to maintain learnt communication skills for lifelong practice, how to assess patient and caregiver understanding during and after these conversations, and how to best scale these protocols at the institutional and national levels.

“If I Become a Vegetable, Then no”: A Thematic Analysis of How Patients and Physicians Refer to Prognosis When Discussing Cardiopulmonary Resuscitation

“…Though evaluation of CPR prognosis can be facilitated by various risk scores (Becker et al, 2020), prognostication remains tainted with uncertainty (Bloom et al, 2022). Expression of this uncertainty by physicians, however, is equated with ignorance and failure by patients (Simpkin & Armstrong, 2019).…”

“…Furthermore, documentation of CPR decisions is required at hospital admission when physicians are unfamiliar with patients, rendering the judgment on the medical indication of CPR rather abstract (A. C. Sterie et al, 2021). Lastly, physicians feel ill-equipped to communicate prognostic information and require more adapted training (Bloom et al, 2022). These various factors impact on whether and how prognosis is discussed with patients, and if the latter can integrate this information into their medical preferences.…”

“…C. Sterie et al, 2021). Lastly, physicians feel ill-equipped to communicate prognostic information and require more adapted training (Bloom et al, 2022). These various factors impact on whether and how prognosis is discussed with patients, and if the latter can integrate this information into their medical preferences.…”

“…Communicating prognosis is considered a core competency for physicians. However, difficulties in incorporating and applying this skill into daily interaction with patients highlight the need to integrate it more into communication training (Bloom et al, 2022).…”

The ALIGN Framework

“…[10][11][12][13] Many existing prognostic communication frameworks were developed to support conversations about the potential for survival. 14 Conversations in the neonatal and infant context are rarely about survival and more often center on the potential for life with neurologic impairment. 15 These differences underscore the need for dedicated study of parent preferences for prognostic communication in the context of potential neurologic impairment.…”