Timing of Prognostic Discussions in People with Advanced Cancer: a Systematic Review

Overview

Journal Support Care Cancer

Specialties Critical Care
Oncology

Date 2024 Jan 23

PMID 38261070

Authors

Sharon H Nahm

Shalini Subramaniam

Martin R Stockler

Belinda E Kiely

Affiliations

Soon will be listed here.

Abstract

Purpose: Many people with cancer (patients) want to know their prognosis (a quantitative estimate of their life expectancy) but this is often not discussed or poorly communicated. The optimal timing of prognostic discussions with people with advanced cancer is highly personalised and complex. We aimed to find, organise, and summarise research regarding the timing of discussions of prognosis with people with advanced cancer.

Methods: We conducted a systematic review of publications from databases, clinical practice guidelines, and grey literature from inception to 2023. We also searched the reference lists of systematic reviews, editorials, and clinical trial registries. Eligibility criteria included publications regarding adults with advanced cancer that reported a timepoint when a discussion of prognosis occurred or should occur.

Results: We included 63 of 798 identified references; most of which were cross-sectional cohort studies with a range of 4-9105 participants. Doctors and patients agreed on several timepoints including at diagnosis of advanced cancer, when the patient asked, upon disease progression, when there were no further anti-cancer treatments, and when recommending palliative care. Most of these timepoints aligned with published guidelines and expert recommendations. Other recommended timepoints depended on the doctor's clinical judgement, such as when the patient 'needed to know' or when the patient 'seemed ready'.

Conclusions: Prognostic discussions with people with advanced cancer need to be individualised, and there are several key timepoints when doctors should attempt to initiate these conversations. These recommended timepoints can inform clinical trial design and communication training for doctors to help improve prognostic understanding.

References

Russell B, Ward A . Deciding what information is necessary: do patients with advanced cancer want to know all the details?. Cancer Manag Res. 2011; 3:191-9. PMC: 3139480. DOI: 10.2147/CMR.S12998. View

Horlait M, Chambaere K, Pardon K, Deliens L, Van Belle S . What are the barriers faced by medical oncologists in initiating discussion of palliative care? A qualitative study in Flanders, Belgium. Support Care Cancer. 2016; 24(9):3873-81. DOI: 10.1007/s00520-016-3211-5. View

Hui D, Paiva C, Del Fabbro E, Steer C, Naberhuis J, van de Wetering M . Prognostication in advanced cancer: update and directions for future research. Support Care Cancer. 2019; 27(6):1973-1984. PMC: 6500464. DOI: 10.1007/s00520-019-04727-y. View

Gordon E, Daugherty C . 'Hitting you over the head': oncologists' disclosure of prognosis to advanced cancer patients. Bioethics. 2003; 17(2):142-68. DOI: 10.1111/1467-8519.00330. View

Mori M, Shimizu C, Ogawa A, Okusaka T, Yoshida S, Morita T . A National Survey to Systematically Identify Factors Associated With Oncologists' Attitudes Toward End-of-Life Discussions: What Determines Timing of End-of-Life Discussions?. Oncologist. 2015; 20(11):1304-11. PMC: 4718424. DOI: 10.1634/theoncologist.2015-0147. View

Clayton J, Butow P, Tattersall M . When and how to initiate discussion about prognosis and end-of-life issues with terminally ill patients. J Pain Symptom Manage. 2005; 30(2):132-44. DOI: 10.1016/j.jpainsymman.2005.02.014. View

Mitchison D, Butow P, Sze M, Aldridge L, Hui R, Vardy J . Prognostic communication preferences of migrant patients and their relatives. Psychooncology. 2011; 21(5):496-504. DOI: 10.1002/pon.1923. View

Turner J, Zapart S, Pedersen K, Rankin N, Luxford K, Fletcher J . Clinical practice guidelines for the psychosocial care of adults with cancer. Psychooncology. 2005; 14(3):159-73. DOI: 10.1002/pon.897. View

Scott I . What does the future hold? The need to engage in discussions around prognosis. Intern Med J. 2016; 46(8):873-5. DOI: 10.1111/imj.13145. View

10.

Smith T, Longo D . Talking with patients about dying. N Engl J Med. 2012; 367(17):1651-2. DOI: 10.1056/NEJMe1211160. View

11.

Villalobos M, Siegle A, Hagelskamp L, Jung C, Thomas M . Communication along Milestones in Lung Cancer Patients with Advanced Disease. Oncol Res Treat. 2019; 42(1-2):41-46. DOI: 10.1159/000496407. View

12.

Chu C, Anderson R, White N, Stone P . Prognosticating for Adult Patients With Advanced Incurable Cancer: a Needed Oncologist Skill. Curr Treat Options Oncol. 2020; 21(1):5. PMC: 6965075. DOI: 10.1007/s11864-019-0698-2. View

13.

Vasista A, Stockler M, Martin A, Lawrence N, Kiely B . Communicating prognostic information: what do oncologists think patients with incurable cancer should be told?. Intern Med J. 2020; 50(12):1492-1499. DOI: 10.1111/imj.14739. View

14.

Liu P, Landrum M, Weeks J, Huskamp H, Kahn K, He Y . Physicians' propensity to discuss prognosis is associated with patients' awareness of prognosis for metastatic cancers. J Palliat Med. 2014; 17(6):673-82. PMC: 4038989. DOI: 10.1089/jpm.2013.0460. View

15.

Keating N, Landrum M, Rogers Jr S, Baum S, Virnig B, Huskamp H . Physician factors associated with discussions about end-of-life care. Cancer. 2010; 116(4):998-1006. PMC: 2819541. DOI: 10.1002/cncr.24761. View

16.

Epstein A, Kakarala S, Reyna V, Saxena A, Maciejewski P, Shah M . Development of the Oncolo-GIST ("Giving Information Strategically & Transparently") Intervention Manual for Oncologist Skills Training in Advanced Cancer Prognostic Information Communication. J Pain Symptom Manage. 2020; 62(1):10-19.e4. PMC: 8155099. DOI: 10.1016/j.jpainsymman.2020.11.023. View

17.

Clayton J, Butow P, Arnold R, Tattersall M . Fostering coping and nurturing hope when discussing the future with terminally ill cancer patients and their caregivers. Cancer. 2005; 103(9):1965-75. DOI: 10.1002/cncr.21011. View

18.

Einstein D, Einstein K, Mathew P . Dying for Advice: Code Status Discussions between Resident Physicians and Patients with Advanced Cancer--A National Survey. J Palliat Med. 2015; 18(6):535-41. DOI: 10.1089/jpm.2014.0373. View

19.

Parker S, Clayton J, Hancock K, Walder S, Butow P, Carrick S . A systematic review of prognostic/end-of-life communication with adults in the advanced stages of a life-limiting illness: patient/caregiver preferences for the content, style, and timing of information. J Pain Symptom Manage. 2007; 34(1):81-93. DOI: 10.1016/j.jpainsymman.2006.09.035. View

20.

Kirk P, Kirk I, Kristjanson L . What do patients receiving palliative care for cancer and their families want to be told? A Canadian and Australian qualitative study. BMJ. 2004; 328(7452):1343. PMC: 420285. DOI: 10.1136/bmj.38103.423576.55. View