[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 34.238.248.103. Please contact the publisher to request reinstatement.
[Skip to Content Landing]
Original Investigation
November 2016

Determinants of Patient-Oncologist Prognostic Discordance in Advanced Cancer

Author Affiliations
  • 1School of Nursing, University of Rochester, Rochester, New York
  • 2Division of Palliative Medicine, University of Vermont, Burlington
  • 3Department of Family Medicine, University of Vermont, Burlington
  • 4Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York
  • 5Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, New York
  • 6Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
  • 7Division of Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, New York
  • 8Center for Community Health, University of Rochester School of Medicine and Dentistry, Rochester, New York
  • 9Center for Healthcare Policy and Research, University of California, Davis, Sacramento
  • 10Department of Psychology, Tulane University, New Orleans, Louisiana
  • 11Tulane Cancer Center, Tulane University, New Orleans, Louisiana
  • 12Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York
  • 13Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
  • 14James P. Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, New York
  • 15Department of Family and Community Medicine, University of California, Davis, Sacramento
  • 16UC Davis Comprehensive Cancer Center, University of California, Davis, Sacramento
  • 17Department of Pediatrics, University of California, Davis, Sacramento
  • 18Division of General Medicine, University of California, Davis, Sacramento
JAMA Oncol. 2016;2(11):1421-1426. doi:10.1001/jamaoncol.2016.1861
Key Points

Question  When patients with advanced cancer report beliefs about their survival prognosis that differ from the expectations of their oncologists, how often do they know that their beliefs differ?

Findings  In this cross-sectional analysis of 236 patients and 38 oncologists, 68% of patients held opinions about their survival prognosis that differed from their oncologist and only 1 in 10 discordant patients knew that their opinions differed.

Meaning  In this study, patient-oncologist discordance about survival prognosis was common and usually due to patients’ inaccurate understanding of their oncologists’ expectations.

Abstract

Importance  Patients with advanced cancer often report expectations for survival that differ from their oncologists’ expectations. Whether patients know that their survival expectations differ from those of their oncologists remains unknown. This distinction is important because knowingly expressing differences of opinion is important for shared decision making, whereas patients not knowing that their understanding differs from that of their treating physician is a potential marker of inadequate communication.

Objective  To describe the prevalence, distribution, and proportion of prognostic discordance that is due to patients’ knowingly vs unknowingly expressing an opinion that differs from that of their oncologist.

Design, Setting, and Participants  Cross-sectional study conducted at academic and community oncology practices in Rochester, New York, and Sacramento, California. The sample comprises 236 patients with advanced cancer and their 38 oncologists who participated in a randomized trial of an intervention to improve clinical communication. Participants were enrolled from August 2012 to June 2014 and followed up until October 2015.

Main Outcomes and Measures  We ascertained discordance by comparing patient and oncologist ratings of 2-year survival probability. For discordant pairs, we determined whether patients knew that their opinions differed from those of their oncologists by asking the patients to report how they believed their oncologists rated their 2-year survival.

Results  Among the 236 patients (mean [SD] age, 64.5 [11.4] years; 54% female), 161 patient-oncologist survival prognosis ratings (68%; 95% CI, 62%-75%) were discordant. Discordance was substantially more common among nonwhite patients compared with white patients (95% [95% CI, 86%-100%] vs 65% [95% CI, 58%-73%], respectively; P = .03). Among 161 discordant patients, 144 (89%) did not know that their opinions differed from that of their oncologists and nearly all of them (155 of 161 [96%]) were more optimistic than their oncologists.

Conclusions and Relevance  In this study, patient-oncologist discordance about survival prognosis was common and patients rarely knew that their opinions differed from those of their oncologists.

×