Prognostic Disclosure and its Influence on Cancer Patients

Abstract

BackgroundPrognostic disclosure is a show of respect for patient autonomy. Only patients who are aware of their prognosis can participate in discussions about their medical condition and make decisions that meet their individual preferences. Despite the abundant literature on this topic, no systematic estimates of prognostic disclosure in cancer patients are available and relatively little research has focused on the impact of prognostic awareness and disclosure on cancer patients. MethodsThe literature on prognostic awareness and disclosure in cancer patients was systematically reviewed and subjected to a meta-analysis. ResultsThe literature search retrieved 25 articles for meta-analysis. The pooled proportion of preferences for prognostic information and prognostic disclosure was calculated. Most cancer patients expressed a preference for prognostic disclosure [84.6%, 95% confidence interval (CI) 74.1%-91.4%)], but only about half were told their prognosis (49.3%, 95% CI 36.4%- 62.3%). These results indicate a gap between cancer patients’ preferences for prognostic disclosure and their actual receipt of prognosis. Cancer patients who are not told their prognosis may have several negative consequences, including inappropriate prognostic awareness, receiving futile treatment at the end of life, being unprepared for death, increased psychological and mental distress as well as social and spiritual suffering, and decreased quality of life. The discrepancy between patients’ preferred and actual prognostic disclosure is primarily due to physicians’ difficulty in revealing the prognosis; this difficulty stems from inaccurate estimates of prognosis, attitudes of beneficence and maintaining patients’ hope, lack of good communication skills, and not knowing patients’ preferences for prognostic information. ConclusionsIn order to close the gap between patients’ preferences for prognostic disclosure and actual receipt of prognostic information, healthcare professionals should develop interventions to overcome the physicians’ difficulty in revealing prognosis, thus facilitating cancer patients’ awareness of prognosis and providing high quality end-of-life care.