Communicating Diagnosis and Prognosis to Patients With Cancer: Guidance for Healthcare Professionals

Linda Emanuel, MD, PhD; Frank D. Ferris, MD, FAAPHM; Charles F. von Gunten, MD, PhD; Jaime H. Von Roenn, MD

Disclosures

January 07, 2011

In This Article

Summary: Determining Prognosis and Communicating Effectively

The 6-step protocol for communicating effectively provides a tool to guide the communication and confirmation of diagnosis and prognosis. Prognostication is an inexact science, and physicians are often overly optimistic with their survival estimates. Multiple sources of prognostic information (eg, clinician estimates of survival, signs and symptoms, the Karnofsky performance scale, stage-specific survival data, and integrated models) are available. Patient performance status, as measured by the KPS, the PPS, and the ECOG, is an independent prognostic factor that is highly predictive of survival, especially when scores are low. For patients with very advanced disease and an anticipated survival of less than 3 months, some symptoms (eg, dyspnea) are highly predictive of survival less than 1 month.

Prognosis is more difficult to predict for patients with advanced disease and a longer anticipated survival. Some cancer complications redefine prognosis for this group. For many of these patients, prognostic information is inadequate, and further research is needed.

Key Take-Home Points

  • Physicians are often overly optimistic with their survival estimates;

  • Inquire why the patient and family are asking about prognosis to have a sense of their context for the question;

  • Give as accurate an estimate of prognosis as you can, when requested; and

  • The 6-step protocol for communicating effectively provides a tool for clarification of diagnosis and prognosis.

Pearls

  • The shorter the anticipated survival, the more accurate physician predictions of survival;

  • Hypercalcemia, pleural effusion, and brain metastasis portend a poor prognosis; and

  • Make a partnership with your patient and the family caregiver; draw them into the interdisciplinary team and foster their active participation in the care plan.

Pitfalls

  • Trying to "soften the blow" -- the patient and family may not understand the significance of the message; and

  • Failing to clarify terms: be sure patients and families understand how response does and does not relate to cure.

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