title: Patient-oncologist communication in advanced cancer: predictors of patient perception of prognosis.
abstract: OBJECTIVE
  Advanced cancer patients' perceptions of prognosis, which are often overly optimistic compared to oncologist estimates, influence treatment preferences. The predictors of patients' perceptions and the effect of oncologist communication on patient understanding are unclear. This study was designed to identify the communication factors that influence patient-oncologist concordance about chance of cure.
  
  
  METHODS
  We analyzed audiorecorded encounters between 51 oncologists and 141 advanced cancer patients with good (n = 69) or poor (n = 72) concordance about chance of cure. Encounters were coded for communication factors that might influence oncologist-patient concordance, including oncologist statements of optimism and pessimism.
  
  
  RESULTS
  Oncologists made more statements of optimism (mean = 3.3 per encounter) than statements of pessimism (mean = 1.2 per encounter). When oncologists made at least one statement of pessimism, patients were more likely to agree with their oncologist's estimated chance of cure (OR = 2.59, 95%CI = 1.31-5.12). Statements of optimism and uncertainty were not associated with an increased likelihood that patients would agree or disagree with their oncologists about chance of cure.
  
  
  CONCLUSIONS
  Communication of pessimistic information to patients with advanced cancer increases the likelihood that patients will report concordant prognostic estimates. Communication of optimistic information does not have any direct effect. The best communication strategy to maximize patient knowledge for informed decision making while remaining sensitive to patients' emotional needs may be to emphasize optimistic aspects of prognosis while also consciously and clearly communicating pessimistic aspects of prognosis.
authors.affiliation: Duke University School of Medicine, Durham, NC, USA. tracy.robinson@vanderbilt.edu
authors.forename: Tracy M
authors.initials: TM
authors.lastname: Robinson
authors.forename: Stewart C
authors.initials: SC
authors.lastname: Alexander
authors.forename: Margie
authors.initials: M
authors.lastname: Hays
authors.forename: Amy S
authors.initials: AS
authors.lastname: Jeffreys
authors.forename: Maren K
authors.initials: MK
authors.lastname: Olsen
authors.forename: Keri L
authors.initials: KL
authors.lastname: Rodriguez
authors.forename: Kathryn I
authors.initials: KI
authors.lastname: Pollak
authors.forename: Amy P
authors.initials: AP
authors.lastname: Abernethy
authors.forename: Robert
authors.initials: R
authors.lastname: Arnold
authors.forename: James A
authors.initials: JA
authors.lastname: Tulsky
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D032882:Comprehension; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000523:psychology*; D010465:Perception; D010817:Physician-Patient Relations; D010865:Pilot Projects; D011379:Prognosis