Expert Point of View: Eduardo Bruera, MD, FAAHPM

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The study by Weeks and colleagues is an important one that shows quite unexpected results. There are three main possible reasons for the very low rate of accurate reporting by the patients: (1) Physicians are not communicating prognosis adequately. (2) Patients are unable to understand the information provided by their physicians—eg, the use of terms such as “response” or “tumor shrinkage” might be interpreted as associated with cure in some cases. (3) Patients are in denial—ie, after receiving appropriate information and understanding it cognitively, many patients are unable to cope emotionally and proceed to deny the information.

It is likely that all three mechanisms are present in this population, and in some cases more than one mechanism may be present in a given patient. Future research needs to “personalize” the causes for inaccurate statements of prognosis. For the first two mechanisms, better communication techniques may be very helpful. For the third mechanism, compassionate care and respect for the patient’s chosen coping mechanism will be important, even though it may be distressing for clinicians and family. ■

Disclosure: Dr. Bruera reported no potential conflicts of interest.

Dr. Bruera is Department Chair, Department of Palliative Care and Rehabilitation Medicine, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston.

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