Miscommunication common between dying cancer patients and their doctors, study says

Most patients with advanced cancer view their odds of survival more optimistically than their doctors, say researchers who point to the "urgent clinical and societal need" for oncologists to communicate better to avoid misunderstandings.

The researchers surveyed 236 U.S. patients with stage 3 or 4 cancer whose doctors "would not have been surprised" if the patients died within a year. They gave a similar questionnaire to 38 oncologists who treated the patients.

Among patients, more than two of three (68 per cent) rated their survival prognosis differently than their oncologists. Of these, 155 of 161, or 96 per cent, rated their prognosis more optimistically, study co-author Dr. Ronald M. Epstein, a professor of family medicine, psychiatry, and oncology at the University of Rochester Medical Center and his team said in Thursday's issue of the journal JAMA Oncology.

"Of course, it's only possible for doctors to provide a ballpark estimate about life expectancy — and some people do beat the odds," Epstein said in a release. "Positive thinking by patients can improve quality of life. But when a patient with very advanced cancer says that he has a 90 to 100 per cent chance of being alive in two years and his oncologist believes that chance is more like 10 per cent, there's a problem."

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In many fields of medicine, the researchers say, patients, families and their doctors often craft an unwritten social contract to maintain unbalanced positivism.

Even when doctors are trained and experienced at delivering a bad prognosis, they avoid doing it. In one previous study, physicians gave patients with advanced or incurable cancer frank answers 37 per cent of the time, favouring an inaccurate response (40 per cent) or no response (23 per cent).

Patients often in the dark

The findings of the latest study suggest the mismatch between patients and oncologists on prognosis is usually caused by patients not knowing their physicians' opinion. Only one in 10 patients with a survival expectation that differed from the oncologist's opinion was aware of the discordance. 

"This study supports the urgent clinical and societal need to better understand what it means to communicate well about prognosis to achieve treatment that honours patients' values, preferences and wishes," the study's authors concluded.

Since the study participants were in a large clinical trial testing how to support communication about advanced cancer, the findings may not reflect what really happens in clinical encounters between patients and their oncologists, the researchers said.

A journal commentary published with the study called it an "important contribution." Future analyses comparing audio recordings of the visits could reveal if the intervention to promote communication made a difference in other ways.