title: Prognostic communication in cancer: A critical interpretive synthesis of the literature.
abstract: OBJECTIVE
  For patients with cancer, providing appropriate information about prognosis or chances of recurrent disease remains a difficult area of practice. Much research has suggested that patients want to be given all available information, although the realities of attempting to do this are complex and may be perceived by some as uncaring. A review of recent literature was undertaken to explore the process of disclosure, patient experience and preferences for information regarding prognosis or risk of recurrence.
  
  
  METHODS
  A systematic approach was taken to searching electronic databases for relevant literature from 2004 to June 2014. Primary research from a range of methodological approaches was included and critical interpretive synthesis was employed to explore themes and identify gaps in the evidence.
  
  
  RESULTS
  Twenty papers were identified as appropriate. They were diverse in objectives and patient groups. Themes identified included: the nature of prognostic information, patient need for prognostic information, patient need to maintain hope, balancing hope and realism, patient factors, disease factors and clinician factors. A thematic framework was developed.
  
  
  CONCLUSIONS
  Patients often struggle to fully understand complex prognostic information. They value help in making sense of this information and generally want information that supports hope. Working with patients to understand and manage the uncertainty of their situation may be particularly valuable. Further research is needed to fully understand the process of prognostic information giving and what information patients want regarding recurrence risk. Research should be aimed at identifying strategies helpful to patients in managing uncertainty inherent in their situation.
authors.affiliation: Royal Brompton and Harefield NHS Foundation Trust, London, UK. Electronic address: m.johnson@rbht.nhs.uk.
authors.forename: Matthew
authors.initials: M
authors.lastname: Johnson
authors.affiliation: School of Nursing, Midwifery and Social Work, University of Manchester, UK.
authors.forename: Angela Mary
authors.initials: AM
authors.lastname: Tod
authors.affiliation: Centre for Health and Social Care Research, Sheffield Hallam University, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Brummell
authors.affiliation: Centre for Health and Social Care Research, Sheffield Hallam University, UK.
authors.forename: Karen
authors.initials: K
authors.lastname: Collins
mesh_terms: D000368:Aged; D003142:Communication; D018450:Disease Progression; D005260:Female; D066275:Health Information Exchange; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008490:Medical Informatics / Q000458:organization & administration*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000523:psychology*; D009369:Neoplasms / Q000503:physiopathology* / Q000523:psychology*; D057240:Patient Preference / Q000706:statistics & numerical data*; D011379:Prognosis; D018570:Risk Assessment; D006113:United Kingdom
keywords: Cancer; Communication; Information; Prognosis; Recurrence risk