title: Giving honest information to patients with advanced cancer maintains hope.
abstract: BACKGROUND
  Oncologists often do not give honest prognostic and treatment-effect information to patients with advanced disease. One of the primary reasons stated for witholding this information is to "not take away hope." We could find no study that tested if hope was influenced by honest clinical information.
  
  
  METHODS
  We tested decision-aids in 27 patients with advanced cancer who were facing first-, second-, third-, and fourth-line chemotherapy. These aids had printed estimates of treatment effect and the patient's chance of survival and being cured (always zero). We measured hope using the Herth Hope Index, which ranks patients' responses to 12 questions and yields a maximum score of 48.
  
  
  RESULTS
  The scores on the Herth Hope Index did not change and the patients remained uniformly hopeful about their future. The pretest score was 44.2 (SD 3.9), and it increased to 44.8 (SD 3.86; P = .55 by paired Student's t-test).
  
  
  CONCLUSIONS
  Hope is maintained when patients with advanced cancer are given truthful prognostic and treatment information, even when the news is bad.
authors.affiliation: Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia, USA. tsmith5@mcvh-vcu.edu
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Smith
authors.forename: Lindsay A
authors.initials: LA
authors.lastname: Dow
authors.forename: Enid
authors.initials: E
authors.lastname: Virago
authors.forename: James
authors.initials: J
authors.lastname: Khatcheressian
authors.forename: Laurel J
authors.initials: LJ
authors.lastname: Lyckholm
authors.forename: Robin
authors.initials: R
authors.lastname: Matsuyama
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000523:psychology*; D010817:Physician-Patient Relations; D011379:Prognosis; D011788:Quality of Life; D014342:Truth Disclosure