Communicating with realism and hope: incurable cancer patients' views on the disclosure of prognosis.
OBJECTIVE
To identify preferences for the process of prognostic discussion among patients with incurable metastatic cancer and variables associated with those preferences.


METHODS
One hundred twenty-six (58%) of 218 patients invited onto the study participated. Eligible patients were the consecutive metastatic cancer patients of 30 oncologists, who were diagnosed within 6 weeks to 6 months before recruitment, over 18 years of age, and without known mental illness. Patients completed a postal survey measuring patient preferences for the manner of delivery of prognostic information, including how doctors might instill hope.


RESULTS
Ninety-eight percent of patients wanted their doctor to be realistic, provide an opportunity to ask questions, and acknowledge them as an individual when discussing prognosis. Doctor behaviors rated the most hope giving included offering the most up to date treatment (90%), appearing to know all there is to know about the patient's cancer (87%), and saying that pain will be controlled (87%). The majority of patients indicated that the doctor appearing to be nervous or uncomfortable (91%), giving the prognosis to the family first (87%), or using euphemisms (82%) would not facilitate hope. Factor analysis revealed six general styles and three hope factors; the most strongly endorsed styles were realism and individualized care and the expert/positive/collaborative approach. A range of demographic, psychological, and disease factors were associated with preferred general and hope-giving styles, including anxiety, information-seeking behavior, expected survival, and age.


CONCLUSIONS
The majority of patients preferred a realistic and individualized approach from the cancer specialist and detailed information when discussing prognosis.
Hagerty
Rebecca G
RG
Medical Psychology Research Unit, University of Sydney, New South Wales 2006, Australia.
Butow
Phyllis N
PN
Ellis
Peter M
PM
Lobb
Elizabeth A
EA
Pendlebury
Susan C
SC
Leighl
Natasha
N
MacLeod
Craig
C
Mac Leod
Craig
C
Tattersall
Martin H N
MH
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003142:Communication; D005163:Factor Analysis, Statistical; D005190:Family; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D010817:Physician-Patient Relations; D011379:Prognosis; D011795:Surveys and Questionnaires; D019452:Terminally Ill / Q000523:psychology*; D014342:Truth Disclosure