Paper in Journal of Clinical
- Rebecca G. Hagerty, Phyllis N.
Butow, Peter M. Ellis, Elizabeth A. Lobb, Susan C. Pendlebury,
Natasha Leighl, Craig Mac Leod, and Martin H.N. Tattersall (2005).
Communicating with realism and hope: Incurable cancer patients'
views on the disclosure of prognosis. Journal of Clinical
Oncology, 23(6): 1278 - 88.
To identify preferences for the process of prognostic discussion
among patients with incurable metastatic cancer and variables associated
with those preferences.
Patients and Methods
One hundred twenty-six (58%) of 218 patients invited onto the study
participated. Eligible patients were the consecutive metastatic
cancer patients of 30 oncologists, who were diagnosed within 6 weeks
to 6 months before recruitment, over 18 years of age, and without
known mental illness. Patients completed a postal survey measuring
patient preferences for the manner of delivery of prognostic information,
including how doctors might instill hope.
Ninety-eight percent of patients wanted their doctor to be realistic,
provide an opportunity to ask questions, and acknowledge them as
an individual when discussing prognosis. Doctor behaviors rated
the most hope giving included offering the most up to date treatment
(90%), appearing to know all there is to know about the patient's
cancer (87%), and saying that pain will be controlled (87%). The
majority of patients indicated that the doctor appearing to be nervous
or uncomfortable (91%), giving the prognosis to the family first
(87%), or using euphemisms (82%) would not facilitate hope. Factor
analysis revealed six general styles and three hope factors; the
most strongly endorsed styles were realism and individualized care
and the expert/positive/collaborative approach. A range of demographic,
psychological, and disease factors were associated with preferred
general and hope-giving styles, including anxiety, information-seeking
behavior, expected survival, and age.
The majority of patients preferred a realistic and individualized
approach from the cancer specialist and detailed information when