An accurate prognosis for a patient with incurable cancer can help a family make important end-of-life decisions. However, previous research shows that many (or even most) patients with advanced cancer misunderstand their prognosis. A study published in the Journal of Oncology Practice explored doctor-patient conversations at four major academic medical centers to show that patients and their doctors naturally avoid difficult discussions about a challenging prognosis. The paper also pinpoints an opportunity to create a space for this discussion to take place. After communicating test results, an oncologist who asks, “Would you like to talk about what this means?” prompts patients to consider how much they want to know and gives them permission to explore a serious discussion about life and death.
“It was surprising – at all four of these medical centers, the conversations that oncologists had with their patients tended to follow the same pattern. They would discuss symptoms, then the oncologist would reveal scan results often followed by an immediate transition to talking about the next steps for treatment. What’s often missing is a discussion of what the scan results mean,” says Sarguni Singh, MD, oncology hospitalist at the University of Colorado Cancer Center. Singh performed her study during residency at the University of Wisconsin with mentor Toby C. Campbell, MD.