- Healthcare experts may have disproven a common patient-provider relationship myth stating that conversations about poor patient prognosis can harm patient satisfaction. This in fact may not be the case, with patients reporting better relationships with providers when prognosis talks are transparent, according to recent research.
Clinicians treating patients with serious illness such as advanced stage cancer have long feared that discussing end-of-life care, life expectancy, or a poor prognosis could harm the patient experience.
“Several lines of evidence suggest that oncologists may avoid frank discussions of prognosis out of fear of disrupting the physician-patient relationship,” the researchers explained.
Some studies have shown that patients with advanced cancer with low likelihood of chemotherapy response have high satisfaction after discussion chemotherapy options. A separate study showed that discussions of end-of-life and palliative care increased patient depressive symptoms, the research team pointed out.
But other research has challenged those conclusions. Additionally, the risks of forgoing prognosis discussions are high and industry professionals should carefully assess the evidence for avoiding those talks, the team noted.
“Patients with life-limiting illnesses rely on physicians to communicate complex clinical and prognostic information while also attending to patient symptoms and emotions,” the research team explained. “In advanced cancer, patients need accurate prognostic information, yet physicians often emphasize treatment options during patient interactions to the exclusion of prognostic discussion or end-of-life planning.”
When providers neglect or gloss over prognosis conversations, patients may be more likely to defer hospice services, use intensive hospital-based services at a higher rate, incur higher healthcare costs, reduce quality of life at the end of life, and create more difficult bereavement for family caregivers.
An assessment of patient-provider relationships among 265 adult cancer patients showed that providers can avoid those consequences, carry out prognosis talks, and still maintain quality patient relationships.
Researchers analyzed audio recordings of prognosis conversations between patients and 38 oncologists at community health and hospital-based cancer clinics in New York and California. The team also conducted patient surveys a few days and three months following a visit.
Both the audio analyses and the surveys revealed no statistically significant reduction in patient satisfaction following a prognosis discussion, the researchers reported. In fact, prognosis conversations improved patient satisfaction in many cases.
“Indeed, based on changes in study measures from baseline to three months after audio recorded oncologist visits, patients who had visits with a greater amount of prognostic discussion rated their therapeutic alliance with physicians statistically significantly more favorably than patients whose visits had less prognostic discussion,” the team found.
These findings highlight key elements of what it means to be a doctor relating to her patients, the researchers stated. Balancing the patient-provider relationship and clinical responsibilities is an art that requires finesse and balance.
“High-quality communication transmits information accurately without undermining patients’ hopes for the future,” the researchers said. “Yet, medical training currently devotes little time and limited assessments of these nuanced communication skills, and deficiencies may go undetected and uncorrected.”
In addition to lacking communication skills, oncologists and other physicians may face barriers adequately addressing prognosis with patients. Providers often procrastinate because they don’t believe they themselves are emotionally able to handle the conversation. Clinicians also may lack confidence in their own communication skills to effectively manage the conversation.
When providers do broach end-of-life care and poor prognosis, they often use language and statistics that limit patient understanding. Providers should work on using accessible language that help patients fully understand the state of their condition.
This study may help spark better communication strategies for providers not confident in holding a discussion about poor prognosis. Additionally, the results may encourage providers in holding these essential conversations that can prompt patients to consider end-of-life care and planning.
“Our results provide reassurance that prognostic discussion need not undermine the therapeutic alliance and, in some circumstances, may even strengthen the relationship between patients and oncologists,” the researchers concluded.