Discussion of Cancer Prognosis and the Patient-Physician Relationship

Key Points

  • No worsening of strength of the patient-physician relationship was observed at 2 to 7 days or 3 months after a prognostic discussion.
  • Evidence of patients’ sense of a greater therapeutic alliance was observed.

In a longitudinal cohort study reported in the Journal of Clinical Oncology, Fenton et al found that discussion of cancer prognosis between oncologists and patients did not worsen patient judgment of the quality of the patient-physician relationship.

Study Details

The study involved 265 adult patients with advanced cancer who visited 38 oncologists in community- and hospital-based cancer clinics in Western New York and Northern California. Prognostic discussions were assessed via transcribed and coded audiorecorded visits using the Prognostic and Treatment Choices scale (prognostic discussion scale, PDS) and by patient survey 3 months after clinic visits. The strength of the patient-physician relationship was assessed by patient responses to The Human Connection (THC) scale and the Perceived Efficacy in Patient-Physician Interactions (PEPPI) scale at baseline and at 2 to 7 days and 3 months after clinic visits. The PDS scale covers nine prognosis domains. The THC scale assesses the strength of the patient-physician therapeutic alliance, including assessment of the degree to which patients like, trust, and respect their physician. The PEPPI scale rates patient confidence in obtaining needed information and attention from their physician.

Impact of Prognostic Discussion

Discussion of prognosis during the clinic visit was not associated with a decrease in either THC or PEPPI measurement of strength of the patient-physician relationship at either 2 to 7 days or 3 months. A one-unit increase in the PDS scale during the audiorecorded visit was associated with a nonsignificant improvement on the THC scale at 2 to 7 days (P = .09) and a significant improvement at 3 months (P = .029). A one-unit increase in the PDS scale was not associated with significant changes in the PEPPI scale at either time point.

The investigators concluded: “Prognostic discussion is not intrinsically harmful to the patient-physician relationship and may even strengthen the therapeutic alliance between patients and oncologists.”

The study was supported by National Cancer Institute grants.

Joshua Fenton, MD, MPH, of the Department of Family and Community Medicine, University of California-Davis Medical Center, is the corresponding author of the Journal of Clinical Oncology article. 

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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