P5-15-02: Patients' Views about How Oncologists Should Explain Prognosis in Advanced Cancer.
Authors: Kiely BE , McCaughan G , Christodoulou S , Tattersall MHN , Beale P , Grimison P , Stockler MR 
Published: June 2012

Background

Many women with advanced breast cancer want information about their life expectancy. Understanding the type of information patients want will help oncologists improve their discussions about prognosis. We sought the attitudes of women previously diagnosed with breast cancer to using three scenarios for survival (best case, worst case and most likely) to explain prognosis to people with advanced cancer.

Methods: Members of the Breast Cancer Network Australia (BCNA) review and survey group and oncology clinic attendees with a previous breast cancer diagnosis were invited to complete a questionnaire describing two options for explaining prognosis to a hypothetical patient with incurable cancer who wanted prognostic information: providing either 3 scenarios for survival or just the median survival time. Associations between respondent attitudes and their demographic and tumour characteristics were explored.

Results: Characteristics of the 254 BCNA respondents and the 68 outpatient respondents respectively were: median age 56 years and 54 years; median years since breast cancer diagnosis 6 and 3; college/university educated 70% and 34%; self-report of cancer spread beyond the lymph nodes 10% and 26%. Significantly more respondents agreed that explaining 3 scenarios (vs just the median survival time) would: be easy to understand (92% v 71%), be helpful (94% v 63%), convey hope (68% v 36%), reassure (56% v 30%) and help family members (92% v 65%), with all p-values &lt;0.001. The proportions of respondents agreeing that each of the 3 scenarios should be presented were: best case 92%, worst case 84% and most likely 93%. Although 53% agreed the worst case scenario on its own was likely to upset people, only 31% agreed that explaining all 3 scenarios together was likely to upset people. When asked how they would prefer information about their own prognosis, 92% wanted all 3 scenarios, either with (49%) or without (43%) the estimated median survival. Most respondents (88%) agreed it would be helpful to receive a printed summary of the scenarios for survival. No differences were seen between the BCNA respondents and breast cancer outpatients for attitudes to presenting all 3 scenarios; however, BCNA respondents were significantly less likely than breast cancer outpatients to agree that the median survival was helpful, reassuring or easy to understand. Women with more education were more likely to agree that presenting all 3 scenarios would be helpful (95% v 87%, p=0.04). Age, year of diagnosis, relationship status and extent of disease were not significantly associated with particular attitudes.

Conclusion: Most respondents judged presentation of best case, worst case and most likely scenarios preferable, more helpful and more reassuring than presentation of just the median survival time when oncologists explain prognosis to people with advanced cancer.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-15-02.