Providing clear numerical prognoses does not foster agreement between physicians and patients

According to Amy Sullivan, ScD, of Harvard Medical School in Boston, MA, and colleagues, providing patients with a clear numerical prognosis does not help agreement between physicians and patients about predicted life expectancy and chance of cure.

The researchers tested the hypothesis that consultations in which physicians used unambiguous quantitative prognostic communication would foster more accurate prognostic understanding.

To that end they studied 232 patient consultations with 40 physicians from two academic institutions in HEMA-COMM, an observational study that evaluates doctor-patient communication, using a variety of tools such as surveys, audio recording, and coding. Following data analysis, Dr. Sullivan noted that the median duration of patient-physician consultations was 80 minutes. Over 90% of patients wanted prognostic information (92% of them in quantitative terms). And 77% of patients said that chance of cure would influence their treatment choice. 

After the consultation, 85% of patients said their physicians discussed prognosis. In 77% of consultations, oncologists discussed life expectancy (or survival) in quantitative terms, and in 51% of consultations discussed chance of cure. 

However, one-third of patients overestimated their life expectancy by two or more categories, and 34% overestimated chance of cure by 20 percentage points or more.  Patients who were younger, less optimistic about their prognoses prior to the consultation, did not have a treatment plan prior to their visits, or were judged by their physicians as “actively seeking prognostic information” were more likely to agree with their physicians about prognosis.

But “physician communication behaviors such as provision of quantitative prognostic information without hedging, and inviting questions, were not predictive of patient-physician agreement about prognosis.”