Abstract
BackgroundWhile prognostic information is considered important for treatment decision-making, physicians struggle to communicate prognosis to advanced cancer patients. This systematic review aimed to offer up-to-date, evidence-based guidance on prognostic communication in palliative oncology.MethodsPubMed and PsycInfo were searched until September 2019 for literature on the association between prognostic disclosure (strategies) and patient outcomes in palliative cancer care, and its moderators. Methodological quality was reported.ResultsEighteen studies were included. Concerning prognostic disclosure, results revealed a positive association with patients’ prognostic awareness. Findings showed no or positive associations between prognostic disclosure and the physician-patient relationship or the discussion of care preferences. Evidence for an association with the documentation of care preferences or physical outcomes was lacking. Findings on the emotional consequences of prognostic disclosure were multifaceted. Concerning disclosure strategies, affective communication seemingly reduced patients' physiological arousal and improved perceived physician’s support. Affective and explicit communication showed no or beneficial effects on patients’ psychological well-being and satisfaction. Communicating multiple survival scenarios improved prognostic understanding. Physicians displaying expertise, positivity and collaboration fostered hope. Evidence on demographic, clinical and personality factors moderating the effect of prognostic communication was weak.ConclusionIf preferred by patients, physicians could disclose prognosis using sensible strategies. The combination of explicit and affective communication, multiple survival scenarios and expert, positive, collaborative behaviour likely benefits most patients. Still, more evidence is needed, and tailoring communication to individual patients is warranted.ImplicationsFuture research should examine the effect of prognostic communication on psychological well-being over time and treatment decision-making, and focus on individualising care.
Highlights
IntroductionAntineoplastic treatment options have evolved in the past decades, cancer remains a leading cause of death globally [1–3]
While prognostic information is considered important for treatment decisionmaking, physicians struggle to communicate prognosis to advanced cancer patients
PubMed and PsycInfo were searched until September 2019 for literature on the association between prognostic disclosure and patient outcomes in palliative cancer care, and its moderators
Summary
Antineoplastic treatment options have evolved in the past decades, cancer remains a leading cause of death globally [1–3]. Physicians are able to gain insight into advanced cancer patients’ prognosis and disclose the lifelimiting nature of the disease. Recent therapeutic developments and associated altered disease outcomes challenge oncologists’ prognostic assessments [4]. A vast majority of patients with metastatic cancer wishes to be informed about the expected outcome of their illness [11, 12]. While prognostic information is considered important for treatment decisionmaking, physicians struggle to communicate prognosis to advanced cancer patients. Methods PubMed and PsycInfo were searched until September 2019 for literature on the association between prognostic disclosure (strategies) and patient outcomes in palliative cancer care, and its moderators.
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