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October 28, 1998

Communicating With Patients About Advanced Cancer—Reply

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;280(16):1403-1404. doi:10-1001/pubs.JAMA-ISSN-0098-7484-280-16-jbk1028

In Reply.—Dr Costantini-Ferrando and colleagues confirm our findings that patients with cancer tend to overestimate their prognoses. More important, they shed light on how this failure of communication actually may be contributing to patients' suffering at the end of life. We found that patients' perceptions of their prognoses were associated with a preference for life-extending therapy, which, in turn, was associated with higher rates of adverse events in the last months of life. Costantini-Ferrando and colleagues identify a possible mediator for this effect, namely, that patients' perceptions of their prognoses may be driving their willingness and desire to even discuss palliative care. Their observation that avoidant thinking also was associated with an unwillingness to discuss palliative care decisions underscores how difficult it may be to successfully intervene in this dynamic. Our finding that patients who simply understood that there was at least a 10% probability that they might not survive 6 months had substantially different treatment preferences suggests that these avoidant tendencies need not be fully overcome, however, to help patients make treatment decisions that are consistent with their underlying values.

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