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 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.

Details

Title
Prevalence and Predictors of Physician-Patient Discordance in Prognostic Perceptions in Advanced Cancer
Author
Naomi Cornelia Anna van der Velden 1   VIAFID ORCID Logo  ; Han, Paul K J 2   VIAFID ORCID Logo  ; Hanneke W M van Laarhoven 3   VIAFID ORCID Logo  ; Filip Y F L de Vos 4   VIAFID ORCID Logo  ; Hendriks, Lizza E L 5   VIAFID ORCID Logo  ; Burgers, Sjaak A 6   VIAFID ORCID Logo  ; Dingemans, Anne-Marie C 7   VIAFID ORCID Logo  ; Jan Maarten W van Haarst 8   VIAFID ORCID Logo  ; Dits, Joyce 9 ; Smets, Ellen M A 1   VIAFID ORCID Logo  ; Henselmans, Inge 1   VIAFID ORCID Logo 

 Department of Medical Psychology, Amsterdam UMC Location University of Amsterdam , Amsterdam , The Netherlands 
 Behavioral Research Program, National Cancer Institute , Bethesda, MD , USA 
 Cancer Treatment and Quality of Life, Cancer Center Amsterdam , Amsterdam , The Netherlands 
 Department of Medical Oncology, University Medical Center Utrecht, Utrecht University , Utrecht , The Netherlands 
 Department of Pulmonary Diseases, GROW School for Oncology and Reproduction, Maastricht University Medical Center+ , Maastricht , The Netherlands 
 Department of Thoracic Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Ziekenhuis , Amsterdam , The Netherlands 
 Department of Pulmonary Diseases, Erasmus MC Cancer Institute, Erasmus University Medical Center , Rotterdam , The Netherlands 
 Department of Respiratory Medicine, Tergooi Medical Center , Hilversum , The Netherlands 
 Department of Pulmonology, Franciscus Gasthuis en Vlietland , Rotterdam , The Netherlands 
Pages
e653-e668
Publication year
2023
Publication date
Aug 2023
Publisher
Oxford University Press
ISSN
10837159
e-ISSN
1549490X
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
3191885853
Copyright
© The Author(s) 2023. Published by Oxford University Press. This work is published under http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.