Patients with stage III or IV cancer report far more optimistic expectations for survival than their oncologists think they communicate, according to new research published today in JAMA Oncology.
Effective communication between patients who could be nearing the end of their lives and their doctors is crucial, according to the authors, since this is when quality-of-life decisions merge with discussions about treatment options.
“Our study reinforces the importance of clear and compassionate prognosis communication in advanced illness,” said lead author Robert Gramling, Holly and Bob Miller Chair in Palliative Medicine at the University of Vermont Medical Center. “We need to better understand where, when and how to support high-quality prognosis communication.”
Gramling and his colleagues conducted a clinical trial of more than 200 patients and nearly 40 oncologists at the UC Davis Comprehensive Cancer Center in Sacramento, Calif., and the University of Rochester Medical Center in NY to test an intervention designed to improve communication between doctors and patients. Through a series of questionnaires, patients and their physicians rated the patients’ two-year survival probability. The patients also rated what they believed their oncologists thought about their prognosis.
The researchers found that more than two out of three patients held substantially more optimistic ratings about their prognosis than their oncologists thought they had explained. In addition, the vast majority of patients did not know that their ratings differed at all from the ratings of their oncologists.
They also found that patients who self-identified as black or African American were at substantially higher risk of unknowingly having different opinions than their doctors about prognosis.
“Evidence is mounting about racial disparities in end-of-life care; our findings might point to an important piece of that puzzle and a promising area of work to improve health care for everyone,” Gramling said.
The study authors said their findings highlight the challenges of accurate communication between doctors and patients, especially later-stage cancer patients from diverse backgrounds. Even when doctors believe they are clear, misunderstandings or disagreements can occur.
“We need to develop values-based communication strategies and tools that oncologists can use in talking with patients who are not likely to survive their cancers,” said study co-author Joshua Fenton, an associate professor of family and community medicine at UC Davis whose research focuses on improving physician communication. “Only then can doctors be confident that they have been heard and patients make decisions that are right for them.”
In addition to Gramling and Fenton, study authors were senior author Ronald Epstein, Kevin Fiscella, Paul Duberstein and Sandy Plumb from the University of Rochester; Guibo Xing, Daniel Tancredi and Richard Kravitz from UC Davis; and Michael Hoerger from Tulane University.
Their work was supported by grants from the National Center Institute (numbers RO1CA14041905 and R01CA168387) and the National Institutes of Health (numbers T32MHO18911 and U54GM104940).
More information about UC Davis Health System, including its comprehensive cancer center and Department of Family and Community Medicine, is at www.healthsystem.ucdavis.edu.