Prognostic Disclosure Associated With Improved Understanding of End-of-Life Care

the Oncology Nurse Advisor take:

A multicenter observational study sought to determine how prognostic conversations influence perception of life expectancy, distress, and the patient-physician relationship among patients with advanced cancer.

The study included a cohort of 590 patients with advanced cancer who were asked whether their oncologist disclosed an estimate of prognosis.

They were also asked to estimate their own life expectancy and complete assessments of the patient-physician relationship, distress, advance directives, and end-of-life care preferences.

The researchers found that 71% of patients wanted to know their life expectancy, but only 17.6% recalled their physician disclosing a prognosis; 51% were willing to estimate their own life expectancy.

Those patients who recalled a prognostic disclosure provided more realistic estimates of life expectancy compared with those who did not. In addition, their estimates were less likely to differ from their actual survival.

Patients who recalled prognostic disclosure provided an estimated life expectancy that was decreased by 17.2 months compared with those who did not recall prognostic disclosure.

Longer self-estimates of life expectancy were associated with lower likelihood of do-not-resuscitate orders and preference for life-prolonging over comfort-oriented care.

Prognostic disclosure was not associated with worse patient-physician relationship ratings, and sadness or anxiety were not increased in these patients.