title: Outcomes of Prognostic Disclosure: Associations With Prognostic Understanding, Distress, and Relationship With Physician Among Patients With Advanced Cancer.
abstract: OBJECTIVE
  To determine how prognostic conversations influence perceptions of life expectancy (LE), distress, and the patient-physician relationship among patients with advanced cancer.
  
  
  METHODS
  This was a multicenter observational study of 590 patients with metastatic solid malignancies with progressive disease after ≥ one line of palliative chemotherapy, undergoing follow-up to death. At baseline, patients were asked whether their oncologist had disclosed an estimate of prognosis. Patients also estimated their own LE and completed assessments of the patient-physician relationship, distress, advance directives, and end-of-life care preferences.
  
  
  RESULTS
  Among this cohort of 590 patients with advanced cancer (median survival, 5.4 months), 71% wanted to be told their LE, but only 17.6% recalled a prognostic disclosure by their physician. Among the 299 (51%) of 590 patients willing to estimate their LE, those who recalled prognostic disclosure offered more realistic estimates as compared with patients who did not (median, 12 months; interquartile range, 6 to 36 months v 48 months; interquartile range, 12 to 180 months; P < .001), and their estimates were less likely to differ from their actual survival by > 2 (30.2% v 49.2%; odds ratio [OR], 0.45; 95% CI, 0.14 to 0.82) or 5 years (9.5% v 35.5%; OR, 0.19; 95% CI, 0.08 to 0.47). In adjusted analyses, recall of prognostic disclosure was associated with a 17.2-month decrease (95% CI, 6.2 to 28.2 months) in patients' LE self-estimates. Longer LE self-estimates were associated with lower likelihood of do-not-resuscitate order (adjusted OR, 0.439; 95% CI, 0.296 to 0.630 per 12-month increase in estimate) and preference for life-prolonging over comfort-oriented care (adjusted OR, 1.493; 95% CI, 1.091 to 1.939). Prognostic disclosure was not associated with worse patient-physician relationship ratings, sadness, or anxiety in adjusted analyses.
  
  
  CONCLUSIONS
  Prognostic disclosures are associated with more realistic patient expectations of LE, without decrements to their emotional well-being or the patient-physician relationship.
authors.affiliation: Andrea C. Enzinger and Deborah Schrag, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; and Baohui Zhang and Holly G. Prigerson, Weill Cornell Medical College, New York, NY.
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Enzinger
authors.affiliation: Andrea C. Enzinger and Deborah Schrag, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; and Baohui Zhang and Holly G. Prigerson, Weill Cornell Medical College, New York, NY.
authors.forename: Baohui
authors.initials: B
authors.lastname: Zhang
authors.affiliation: Andrea C. Enzinger and Deborah Schrag, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; and Baohui Zhang and Holly G. Prigerson, Weill Cornell Medical College, New York, NY.
authors.forename: Deborah
authors.initials: D
authors.lastname: Schrag
authors.affiliation: Andrea C. Enzinger and Deborah Schrag, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; and Baohui Zhang and Holly G. Prigerson, Weill Cornell Medical College, New York, NY. hgp2001@med.cornell.edu.
authors.forename: Holly G
authors.initials: HG
authors.lastname: Prigerson
mesh_terms: D000328:Adult; D016223:Advance Directives; D000368:Aged; D032882:Comprehension; D004644:Emotions; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis*; D016017:Odds Ratio; D057240:Patient Preference; D010817:Physician-Patient Relations; D011379:Prognosis; D013315:Stress, Psychological / Q000209:etiology*; D013727:Terminal Care; D014342:Truth Disclosure