Don’t Shoot the Messenger: Experiences of Delivering Prognostic Information in the Context of Advanced Cancer
Open accessAbstract
The study of prognostic understanding is imperative as the trend toward individualized medicine continues. However, without guidelines for discussing prognosis, palliative care clinicians face challenges presenting prognostic information in a way that optimizes patient understanding, psychological adjustment, and decision-making. The present study draws on the experiences of experts in the field of palliative care in order to examine the communication of prognostic information. Fifteen oncology, psycho-oncology, and palliative care professionals with expertise in doctor–patient communication participated in semi-structured interviews that focused on identifying the breadth of factors underlying prognostic understanding, as well as methods to identify and quantify this understanding. Three independent raters utilized a thematic content analysis framework to identify core themes that reflected unique aspects of prognostic understanding. Interviews yielded 2 types of information. Participants described the multifaceted nature of prognostic understanding and identified 5 distinct elements of prognostic understanding: understanding of current state of disease, life expectancy, curability, decline trajectory, and available treatment options. Participants also offered “best practice” techniques, including methods for determining a patient’s preferences for and understanding of prognostic information, assessing patient fears and concerns, and communicating medical uncertainties. Results emphasize the need for clinicians to join with patients to ensure that prognostic information is well understood. These results highlight the salience of health information preferences and strategies to provide comprehensive prognostic information, compassionately and with respect for each individual patient.
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Each element of prognostic understanding exists along a continuum, and an individual may be more or less accurate depending on cancer stage.
“Furthermore, each element exists along a continuum; an individual may be more or less accurate in their understanding of any domain depending on their cancer stage.”
From Measuring a Patient's understanding of their prognosis: An exploratory analysis (2022) · cites this paper as [3]
The Results (Prognostic Understanding) and Discussion identify distinct elements of prognostic understanding and discuss patients having inaccurate expectations about some of them. They do not say that each element lies on a continuum or that accuracy varies depending on cancer stage. (LLM, conf=0.83)
Experimental — accuracy not yet measuredA qualitative study identified multiple components of prognosis: current disease state and likely curability, availability of treatment options, anticipated life expectancy, and likely trajectory of symptoms and/or functioning.
“A recent qualitative study identified multiple components encompassed by the term prognosis, all of which form a patient’s prognostic understanding more generally.3 These domains include the current disease state and its likely curability, the availability of treatment options, anticipated life expectancy, and the likely trajectory of symptoms and/or functioning (i.e., deterioration).”
From Measuring a Patient's understanding of their prognosis: An exploratory analysis (2022) · cites this paper as [3]
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Sorted by citations
Health Information Preferences and Curability Beliefs Among Patients With Advanced Cancer
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“A recent qualitative study by our research team identified multiple components encompassed by the term prognosis, all of which form a patient's prognostic understanding more generally.(3)”
BackgroundSelf-citation
- Authors
- Masterson, M. P., Applebaum, A. J., Buda, K., Reisch, S., & Rosenfeld, B.
- Affiliations
- Memorial Sloan Kettering Cancer Center (US)
- Fordham University (US)
- Corresponding author
- Masterson, Melissa P.
- Venue
- American Journal of Hospice and Palliative Medicine®
- Publisher
- SAGE Publications
- Published
- 2018-06-12
- Volume
- 35
- Issue
- 12
- Pages
- 1526-1531
- ISSN
- 1049-9091 (ISSN-L)
- 1938-2715
- PMC
- PMC7314594
- OpenAlex
- W2807773428
- Cited by
- 21
- References
- 18
- Citations by year
- 2026: 5 · 2025: 1 · 2024: 1 · 2023: 4 · 2022: 4 · 2021: 2 · 2020: 3 · 2019: 1
- FWCI
- 1.43
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Hospice and Palliative Medicine® (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Cancer Institute - Singapore (R21 CA186932-01A1)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Keywords
- prognostic information, prognostic understanding, advanced cancer, palliative care communication, physician-patient communication, life expectancy, curability, treatment options, clinical uncertainty, patient preferences, psycho-oncology, clinician experience
- MeSH terms
- Adult, Communication, Decision Making, Female, Humans, Life Expectancy, Male, Middle Aged, Neoplasms, Palliative Care, Physician-Patient Relations, Prognosis, Quality of Life, Severity of Illness Index, Terminal Care, Qualitative Research, Patient Preference
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