Internal medicine residents' perception of cancer prognosis.

Abstract

e18214 Background: Cancer is the second leading cause of death in the US. Many internal medicine physicians feel uncomfortable having to prognosticate, however oncology patients often ask this of them. The inability to provide an accurate prognosis could lead a patient to make a treatment decision incongruent with their true wishes. We conducted this study to assess resident and attending physicians’ knowledge of cancer prognosis. Methods: We conducted a prospective cross-sectional study to assess internal medicine resident and attending physician knowledge of median survival for seven different oncologic case scenarios. We asked participants to choose a median survival of: (a) ≤6 mo, (b) 10-12 mo, (c) 24-36 mo, or (d) 48-60 mo for each scenario. Residents were asked to identify the source(s) of information that most significantly influenced their choices. All internal medicine residents and attending physicians affiliated with the University of Hawaii Internal Medicine Residency Program were invited to participate. Results: A total of 67 of 85 surveys were completed, representing 41 residents and 26 attending physicians. Overall, the respondents correctly estimated median survival 42.6% of the time. The respondents underestimated more often than overestimated median survival (46.3% vs 14.9%, p = 0.0001). Survival in colon and pancreatic cancer were most often underestimated (61% and 53%, respectively). We found no statistically significant difference between resident and attending physician responses. Of the residents who underestimated survival, 73% sited inpatient experience as influencing their oncologic knowledge. Conclusions: Internal medicine residents and attending physicians correctly estimate median survival of cancer patients less than 50% of the time and often underestimate survival. Inpatient rotations, where residents care for the oncologic patients experiencing significant complications of their cancer and treatment, may be giving them an unbalanced perspective on cancer prognosis. Improving oncologic education to provide a more balanced perspective may be critical in improving perception of prognosis so that patients can be provided with accurate information when trying to make critical treatment decisions.