Prognostic disclosure improves life expectancy estimates
Andrea C. Enzinger, M.D., from the Dana-Farber Cancer Institute in Boston, and colleagues examined the impact of prognostic disclosure among 590 patients with metastatic solid malignancies with progressive disease after one or more lines of palliative chemotherapy. Participants were followed until death (median survival, 5.4 months).
The researchers found that 71 percent of patients wanted to know their LE, but only 17.6 percent recalled a prognostic disclosure. Of the 51 percent of patients willing to estimate their LE, the estimates were more realistic for those who recalled prognostic disclosure versus those who did not (P < 0.001), and their estimates were less likely to differ from their actual survival by more than two or five years (odds ratios, 0.45 and 0.19, respectively). Prognostic disclosure recall correlated with a 17.2-month decrease in patients' LE self-estimate in adjusted analyses. There were correlations for longer LE estimates with lower likelihood of do-not-resuscitate orders and preference for life-prolonging versus comfort-oriented care (adjusted odds ratios, 0.439 and 1.493, respectively). In adjusted analyses, there was no correlation for prognostic disclosure with worse patient-physician relationship, sadness, or anxiety.
"Prognostic disclosures are associated with more realistic patient expectations of LE, without decrements to their emotional well-being or the patient-physician relationship," the authors write.
One author disclosed financial ties to the pharmaceutical industry.
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