Prognostication, Risk and Hope: Understanding When, Why and How Oncologists Share Prognostic Information with Patients

• In Event: 322 - Section on Medical Sociology Roundtable Session
  In Refereed Roundtable: Table 10. Healthcare Practices

Abstract

Introduction: Physician attitudes and adeptness at initiating end-of-life conversations has been shown to be one of the greatest predictors of when patients with advanced metastatic cancer will make the transition from active treatment to end-of-life care. Aim: The aim of this study was to explore the opinions and attitudes of oncologists regarding prognostic and end-of-life conversations with patients who have advanced cancer. Methods: This study used a grounded theory framework and semi-structured interviews. 17 physicians board certified in medical oncology were recruited from two hospitals in major US cities. Findings: Three main strategies for prognostication were identified. These three prognostic strategies were labeled: 1) Quantitative Prognostication; 2) Categorical Prognostication; and 3) Qualified Prognostication. Physicians chose a prognostic strategy based on the personality type of the patient, the point in the disease and treatment trajectory and the desired outcome of the conversation. Physicians’ main goal in picking a prognostic strategy is to help their patients maintain hope. Conclusion: Physicians use different prognostic strategies depending on their understanding of how a patient will process the information.

Author

• Jennifer Elyse James, University of California-San Francisco