Prognosis discussions do not disrupt the patient–physician relationship
medwireNews: Discussing a patient’s prognosis does not harm the patient–physician relationship and may even be beneficial, according to findings from a US-based cohort study.
Although several organizations, including the American Society of Clinical Oncology, have urged oncologists to share prognostic information to reduce patient misconceptions, there is evidence to suggest that oncologists avoid such candid conversations through a fear of disrupting the patient–physician relationship, write Joshua Fenton (University of California, Davis Medical Center, Sacramento, USA) and colleagues in the Journal of Clinical Oncology.
In their study of 265 patients with advanced cancer and 38 oncologists from community- and hospital-based cancer clinics, the researchers found that prognostic conversations were not associated with declines in patients’ perceptions of the strength of their relationship with their oncologist.
Indeed, say the researchers, “patients who had visits with a greater amount of prognostic discussion rated their therapeutic alliance with physicians statistically signiﬁcantly more favorably than patients whose visits had less prognostic discussion.”
Information on patient perceptions of the strength of the physician–patient relationship was gathered using The Human Connection (THC) scale and the Perceived Efficacy in Patient–Physician Interactions (PEPPI) scale at baseline, 2–7 days after an oncologist visit, and 3 months after the visit.
The extent to which oncologists engaged patients in discussions regarding prognosis and treatment options was measured from an audio recording using a prognostic discussion scale (PDS) adapted from the informing subscale of the Prognostic and Treatment Choices scale.
The researchers found that 1- and 2-unit increases in the PDS during the oncologist visit were not, in general, associated with significant changes from baseline in either the THC or PEPPI scale at 2–7 days or 3 months after the visit, indicating no impact on the patient–physician relationship.
The exception was a significant 0.18-point increase for THC at 3 months with a 1-unit increase in the PDS, indicating a strengthening of the therapeutic alliance.
“[O]ur study ﬁndings suggest prognostic disclosure and discussion are not intrinsically harmful to the doctor–patient relationship,” say the researchers, “but may require understanding the patient’s hopes and aspirations, applying tact and skill in sharing information, inquiring into patients ’ emotions, and being sensitive to timing.”
By Catherine Booth
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