title: Physicians' propensity to discuss prognosis is associated with patients' awareness of prognosis for metastatic cancers.
abstract: BACKGROUND
  Prognosis discussion is an essential component of informed decision-making. However, many terminally ill patients have a limited awareness of their prognosis and the causes are unclear.
  
  
  OBJECTIVE
  To explore the impact of physicians' propensity to discuss prognosis on advanced cancer patients' prognosis awareness.
  
  
  METHODS
  Cancer Care Outcomes Research and Surveillance Consortium (CanCORS) study, a prospective cohort study with patient and physician surveys.
  
  
  METHODS
  We investigated 686 patients with metastatic lung or colorectal cancer at diagnosis who participated in the CanCORS study and reported about their life expectancy. Data were linked to the physician survey from 486 physicians who were identified by these patients as filling important roles in their cancer care.
  
  
  RESULTS
  Few patients with metastatic cancers (16.5%) reported an accurate awareness of their prognosis, defined as reporting a life expectancy of less than 2 years for lung cancer or less than 5 years for colorectal cancer. Patients whose most-important-doctor (in helping patient make decisions) reported discussing prognosis with terminally ill patients earlier were more likely than those whose doctors deferred these discussions to have an accurate prognosis awareness (adjusted proportion, 18.5% versus 7.6%; odds ratio, 3.23; 95% confidence interval, 1.39-7.52; p=0.006).
  
  
  CONCLUSIONS
  Few patients with advanced cancer could articulate an accurate prognosis estimate, despite most having received chemotherapy and many physicians reported they would discuss prognosis early. Physicians' propensity to discuss prognosis earlier was associated with more accurate patient reports of prognosis. Enhancing the communication skills of providers with important roles in cancer care may help to improve cancer patients' understanding of their prognosis.
authors.affiliation: 1 Department of Health Care Policy, Harvard Medical School , Boston, Massachusetts.
authors.forename: Pang-Hsiang
authors.initials: PH
authors.lastname: Liu
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Landrum
authors.forename: Jane C
authors.initials: JC
authors.lastname: Weeks
authors.forename: Haiden A
authors.initials: HA
authors.lastname: Huskamp
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Kahn
authors.forename: Yulei
authors.initials: Y
authors.lastname: He
authors.forename: Jennifer W
authors.initials: JW
authors.lastname: Mack
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Keating
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000407:Alabama; D001364:Awareness; D002140:California; D015179:Colorectal Neoplasms / Q000473:pathology*; D003142:Communication; D003657:Decision Making; D005260:Female; D006801:Humans; D007484:Iowa; D016015:Logistic Models; D008175:Lung Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009657:North Carolina; D010817:Physician-Patient Relations; D011379:Prognosis; D011446:Prospective Studies; D019452:Terminally Ill; D013997:Time Factors; D014342:Truth Disclosure; D055815:Young Adult
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