title: Determinants of Patient-Oncologist Prognostic Discordance in Advanced Cancer.
abstract: OBJECTIVE
  Patients with advanced cancer often report expectations for survival that differ from their oncologists' expectations. Whether patients know that their survival expectations differ from those of their oncologists remains unknown. This distinction is important because knowingly expressing differences of opinion is important for shared decision making, whereas patients not knowing that their understanding differs from that of their treating physician is a potential marker of inadequate communication.
  
  
  OBJECTIVE
  To describe the prevalence, distribution, and proportion of prognostic discordance that is due to patients' knowingly vs unknowingly expressing an opinion that differs from that of their oncologist.
  
  
  METHODS
  Cross-sectional study conducted at academic and community oncology practices in Rochester, New York, and Sacramento, California. The sample comprises 236 patients with advanced cancer and their 38 oncologists who participated in a randomized trial of an intervention to improve clinical communication. Participants were enrolled from August 2012 to June 2014 and followed up until October 2015.
  
  
  METHODS
  We ascertained discordance by comparing patient and oncologist ratings of 2-year survival probability. For discordant pairs, we determined whether patients knew that their opinions differed from those of their oncologists by asking the patients to report how they believed their oncologists rated their 2-year survival.
  
  
  RESULTS
  Among the 236 patients (mean [SD] age, 64.5 [11.4] years; 54% female), 161 patient-oncologist survival prognosis ratings (68%; 95% CI, 62%-75%) were discordant. Discordance was substantially more common among nonwhite patients compared with white patients (95% [95% CI, 86%-100%] vs 65% [95% CI, 58%-73%], respectively; P = .03). Among 161 discordant patients, 144 (89%) did not know that their opinions differed from that of their oncologists and nearly all of them (155 of 161 [96%]) were more optimistic than their oncologists.
  
  
  CONCLUSIONS
  In this study, patient-oncologist discordance about survival prognosis was common and patients rarely knew that their opinions differed from those of their oncologists.
authors.affiliation: School of Nursing, University of Rochester, Rochester, New York2Division of Palliative Medicine, University of Vermont, Burlington3Department of Family Medicine, University of Vermont, Burlington4Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York5Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, New York6Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York7Division of Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, New York.
authors.forename: Robert
authors.initials: R
authors.lastname: Gramling
authors.affiliation: Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York5Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, New York6Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York8Center for Community Health, University of Rochester School of Medicine and Dentistry, Rochester, New York.
authors.forename: Kevin
authors.initials: K
authors.lastname: Fiscella
authors.affiliation: Center for Healthcare Policy and Research, University of California, Davis, Sacramento.
authors.forename: Guibo
authors.initials: G
authors.lastname: Xing
authors.affiliation: Department of Psychology, Tulane University, New Orleans, Louisiana11Tulane Cancer Center, Tulane University, New Orleans, Louisiana12Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York.
authors.forename: Michael
authors.initials: M
authors.lastname: Hoerger
authors.affiliation: Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, New York6Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York12Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York.
authors.forename: Paul
authors.initials: P
authors.lastname: Duberstein
authors.affiliation: Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, New York.
authors.forename: Sandy
authors.initials: S
authors.lastname: Plumb
authors.affiliation: Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York14James P. Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, New York.
authors.forename: Supriya
authors.initials: S
authors.lastname: Mohile
authors.affiliation: Center for Healthcare Policy and Research, University of California, Davis, Sacramento15Department of Family and Community Medicine, University of California, Davis, Sacramento16UC Davis Comprehensive Cancer Center, University of California, Davis, Sacramento.
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Fenton
authors.affiliation: Center for Healthcare Policy and Research, University of California, Davis, Sacramento17Department of Pediatrics, University of California, Davis, Sacramento.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Tancredi
authors.affiliation: Center for Healthcare Policy and Research, University of California, Davis, Sacramento16UC Davis Comprehensive Cancer Center, University of California, Davis, Sacramento18Division of General Medicine, University of California, Davis, Sacramento.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Kravitz
authors.affiliation: Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, New York6Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York7Division of Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, New York12Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York14James P. Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, New York.
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Epstein
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D009367:Neoplasm Staging; D009369:Neoplasms / Q000401:mortality / Q000473:pathology / Q000523:psychology* / Q000628:therapy; D000067656:Optimism; D010465:Perception; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D013727:Terminal Care; D014342:Truth Disclosure