August 31, 2015
Question:
Answer:
Most patients with advanced illness have an accurate understanding of their prognosis.
Correct Answer?
Explanation:
In a study of patients of Stage IV non-small cell lung cancer (all of whom signed consent which described the study for patients with advanced lung cancer) with a median life expectancy of 9-12 months, 1 in 3 patients thought their cancer was curable and more than 2 out of 3 patients thought the goal of treatment was to "get rid of the cancer of all of the cancer." (Temel J S et al. JCO 2011;29:2319-2326)
Physicians tend to avoid talking to patients about prognosis.
CORRECT. Physicians often feel uncomfortable offering a prognostic estimate to patients.
Patients cannot ‘hear’ information about poor prognosis or poor outcomes, so discussing prognosis with patients does not change the decisions they make.
When given outcomes of different clinical scenarios, older patients made different decisions about medical interventions, such as CPR. (Schonwetter, R.S. et al. Resuscitation decision making in the elderly: The value of outcome data. J Gen Intern Med 1993;8: 295-300)
Because most physicians over-estimate prognosis, its not helpful to make prognostic predictions about patients.
While physicians do often over-estimate prognosis, patients who understand that they had less than one year to live were less likely to choose more chemotherapy (Weeks, JC. JAMA 1998 279 (21): p. 1709-14.). Thus, discussion of prognosis can have substantial impact on patient decision-making.
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