Prevalence and Predictors of Physician-Patient Discordance in Prognostic Perceptions in Advanced Cancer
van der Velden, Naomi Cornelia Anna; Han, Paul K J; van Laarhoven, Hanneke W M; de Vos, Filip Y F L; Hendriks, Lizza E L; Burgers, Sjaak A; Dingemans, Anne-Marie C; van Haarst, Jan Maarten W; Dits, Joyce; Smets, Ellen M A; Henselmans, Inge
(2023) Oncologist, volume 28, issue 8, pp. e653 - e668
(Article)
Abstract
BACKGROUND: Discordance between physicians' and patients' prognostic perceptions in advanced cancer care threatens informed medical decision-making and end-of-life preparation, yet this phenomenon is poorly understood. We sought to: (1) describe the extent and direction of prognostic discordance, patients' prognostic information preferences in cases of prognostic discordance, and physicians' awareness of
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prognostic discordance; and (2) examine which patient, physician, and caregiver factors predict prognostic discordance. MATERIALS AND METHODS: Oncologists and advanced cancer patients (median survival ≤12 months; n = 515) from 7 Dutch hospitals completed structured surveys in a cross-sectional study. Prognostic discordance was operationalized by comparing physicians' and patients' perceptions of the likelihood of cure, 2-year mortality risk, and 1-year mortality risk. RESULTS: Prognostic discordance occurred in 20% (likelihood of cure), 24%, and 35% (2-year and 1-year mortality risk) of physician-patient dyads, most often involving patients with more optimistic perceptions than their physician. Among patients demonstrating prognostic discordance, the proportion who preferred not knowing prognosis varied from 7% (likelihood of cure) to 37% (1-year mortality risk), and 45% (2-year mortality risk). Agreement between physician-perceived and observed prognostic discordance or concordance was poor (kappa = 0.186). Prognostic discordance was associated with several patient factors (stronger fighting spirit, self-reported absence of prognostic discussions, an information source other than the healthcare provider), and greater physician-reported uncertainty about prognosis. CONCLUSION: Up to one-third of the patients perceive prognosis discordantly from their physician, among whom a substantial proportion prefers not knowing prognosis. Most physicians lack awareness of prognostic discordance, raising the need to explore patients' prognostic information preferences and perceptions, and to tailor prognostic communication.
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Keywords: Cross-Sectional Studies, Humans, Neoplasms/diagnosis, Physician-Patient Relations, Physicians, Prevalence, Prognosis, physician-patient relations, prognosis, life expectancy, health communication, truth disclosure, neoplasm metastases, General Medicine, Research Support, Non-U.S. Gov't, Journal Article
ISSN: 1083-7159
Publisher: AlphaMed Press
Note: Funding Information: We would like to thank all participating patients, caregivers, and physicians from the Amsterdam University Medical Centers, Maastricht University Medical Center+, Antoni van Leeuwenhoek Ziekenhuis, Tergooi Ziekenhuis, University Medical Center Utrecht, Erasmus Medical Center and Franciscus Gasthuis & Vlietland Ziekenhuis. We also thank Maartje Meijers, Rania Ali, Laura Streefkerk and Nora Looze for their contributions to this study’s data collection, and Bill Klein for jointly deliberating interpretations of our results. The authors disclosed receipt of financial support by the Dutch Cancer Society [grant number 11547] for the research of this article. The funder was not involved in the study design, data collection, data analyses, data interpretation, or report of the article. Funding Information: The authors disclosed receipt of financial support by the Dutch Cancer Society [grant number 11547] for the research of this article. The funder was not involved in the study design, data collection, data analyses, data interpretation, or report of the article. Publisher Copyright: © The Author(s) 2023. Published by Oxford University Press.
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