RSS Feeds
Prognostic Disclosure to Patients with Cancer near the End of Life
- Elizabeth B. Lamont, MD, MS; and
- Nicholas A. Christakis, MD, PhD, MPH
Abstract
Background: Patients' understanding of their prognosis informs numerous medical and nonmedical decisions, but patients with cancer and their physicians often have disparate prognostic expectations.
Objective: To determine whether physician behavior might contribute to the disparity between patients' and physicians' prognostic expectations.
Design: Prospective cohort study.
Setting: Five hospices in Chicago, Illinois.
Patients: 326 patients with cancer.
Intervention: Physicians formulated survival estimates and also indicated the survival estimates that they would communicate to their patients if the patients insisted.
Measurements: Comparison of the formulated and communicated prognoses.
Results: For 300 of 311 evaluable patients (96.5%), physicians were able to formulate prognoses. Physicians reported that they would not communicate any survival estimate 22.7% (95% CI, 17.9% to 27.4%) of the time, would communicate the same survival estimate they formulated 37% (CI, 31.5% to 42.5%) of the time, and would communicate a survival estimate different from the one they formulated 40.3% (CI, 34.8% to 45.9%) of the time. Of the discrepant survival estimates, most (70.2%) were optimistically discrepant. Multivariate analysis revealed that older patients were more likely to receive frank survival estimates, that the most experienced physicians and the physicians who were least confident about their prognoses were more likely to favor no disclosure over frank disclosure, and that female physicians were less likely to favor frank disclosure over pessimistically discrepant disclosure.
Conclusions: Physicians reported that even if patients with cancer requested survival estimates, they would provide a frank estimate only 37% of the time and would provide no estimate, a conscious overestimate, or a conscious underestimate most of the time (63%). This pattern may contribute to the observed disparities between physicians' and patients' estimates of survival.
Article and Author Information
-
Acknowledgments: The authors thank Tammy Polonsky and Ellena Linden for help in administering the survey and Ron Thisted and Melinda Drum for statistical consultation.
-
Grant Support: By the Soros Foundation Project on Death in America Faculty Scholars Program (Dr. Christakis), the Robert Wood Johnson Clinical Scholars Program034652 (Dr. Lamont), and the National Institutes of Health (K12 AG-0048-09) (Dr. Lamont).
-
Requests for Single Reprints: Nicholas A. Christakis, MD, PhD, MPH, University of Chicago Medical Center, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637; e-mail, nchrista{at}medicine.bsd.uchicago.edu.
-
Current Author Addresses: Drs. Lamont and Christakis: University of Chicago Medical Center, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637.
-
Author Contributions: Conception and design: N.A. Christakis.
-
Analysis and interpretation of the data: E.B. Lamont, N.A. Christakis.
-
Drafting of the article: E.B. Lamont, N.A. Christakis.
-
Critical revision of the article for important intellectual content: E.B. Lamont, N.A. Christakis.
-
Final approval of the article: E.B. Lamont, N.A. Christakis.
-
Provision of study materials or patients: N.A. Christakis.
-
Statistical expertise: E.B. Lamont, N.A. Christakis.
-
Obtaining of funding: E.B. Lamont, N.A. Christakis.
-
Administrative, technical, or logistic support: N.A. Christakis.
-
Collection and assembly of data: E.B. Lamont, N.A. Christakis.
- Copyright ©2004 by the American College of Physicians
Related Clinical Content
