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Cancer Patient Preferences for Communication of Prognosis in the Metastatic Setting

From the Medical Psychology Research Unit and the Department of Cancer Medicine, University of Sydney, Sydney; and Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.

Address reprint requests to Phyllis Butow, PhD, Medical Psychology Research Unit, Blackburn Building, D06, University of Sydney, Sydney, NSW 2006, Australia; e-mail: phyllisb{at}med.usyd.edu.au

PURPOSE: To identify preferences for and predictors of prognostic information among patients with incurable metastatic cancer.

PATIENTS AND METHODS: One hundred twenty-six metastatic cancer patients seeing 30 oncologists at 12 outpatient clinics in New South Wales, Australia, participated in the study. Patients were diagnosed with incurable metastatic disease within 6 weeks to 6 months of recruitment. Patients completed a survey eliciting their preferences for prognostic information, including type, quantity, mode, and timing of presentation; anxiety and depression levels; and information and involvement preferences.

RESULTS: More than 95% of patients wanted information about side effects, symptoms, and treatment options. The majority wanted to know longest survival time with treatment (85%), 5-year survival rates (80%), and average survival (81%). Words and numbers were preferred over pie charts or graphs. Fifty-nine percent (59%) wanted to discuss expected survival when first diagnosed with metastatic disease. Thirty-eight percent and 44% wanted to negotiate when expected survival and dying, respectively, were discussed. Patients with higher depression scores were more likely to want to know shortest time to live without treatment (P = .047) and average survival (P = .049). Lower depression levels were significantly associated with never wanting to discuss expected survival (P = .03). Patients with an expected survival of years were more likely to want to discuss life expectancy when first diagnosed with metastases (P = .02).

CONCLUSION: Most metastatic cancer patients want detailed prognostic information but prefer to negotiate the extent, format, and timing of the information they receive from their oncologists.

Supported by the New South Wales Cancer Council.

Presented at the 29th Annual Scientific Meeting of the Clinical Oncological Society of Australia, Sydney, 2002.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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