Don’t shoot the messenger: Experiences of delivering prognostic information in the context of advanced cancer Journal Article


Authors: Masterson, M. P.; Applebaum, A. J.; Buda, K.; Reisch, S.; Rosenfeld, B.
Article Title: Don’t shoot the messenger: Experiences of delivering prognostic information in the context of advanced cancer
Abstract: The study of prognostic understanding is imperative as the trend toward individualized medicine continues. However, without guidelines for discussing prognosis, palliative care clinicians face challenges presenting prognostic information in a way that optimizes patient understanding, psychological adjustment, and decision-making. The present study draws on the experiences of experts in the field of palliative care in order to examine the communication of prognostic information. Fifteen oncology, psycho-oncology, and palliative care professionals with expertise in doctor–patient communication participated in semi-structured interviews that focused on identifying the breadth of factors underlying prognostic understanding, as well as methods to identify and quantify this understanding. Three independent raters utilized a thematic content analysis framework to identify core themes that reflected unique aspects of prognostic understanding. Interviews yielded 2 types of information. Participants described the multifaceted nature of prognostic understanding and identified 5 distinct elements of prognostic understanding: understanding of current state of disease, life expectancy, curability, decline trajectory, and available treatment options. Participants also offered “best practice” techniques, including methods for determining a patient’s preferences for and understanding of prognostic information, assessing patient fears and concerns, and communicating medical uncertainties. Results emphasize the need for clinicians to join with patients to ensure that prognostic information is well understood. These results highlight the salience of health information preferences and strategies to provide comprehensive prognostic information, compassionately and with respect for each individual patient. © The Author(s) 2018.
Keywords: palliative care; clinician–patient communication; end of life conversations; prognostic understanding; qualitative data; thematic content analysis
Journal Title: American Journal of Hospice & Palliative Medicine
Volume: 35
Issue: 12
ISSN: 1049-9091
Publisher: Sage Publications  
Date Published: 2018-12-01
Start Page: 1526
End Page: 1531
Language: English
DOI: 10.1177/1049909118780650
PUBMED: 29895170
PROVIDER: scopus
DOI/URL:
Notes: Article -- Export Date: 3 December 2018 -- Source: Scopus
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MSK Authors
  1. Kara Lee Buda
    10 Buda
  2. Sally A Reisch
    5 Reisch