Prognosis and truth-telling

At the heart of prognosis is sharing this evaluation with patients and families. I have often heard clinicians speak of a patient’s prognosis but withhold that information when patients ask - answering instead with vague sentences. I also hear physicians speak honestly with patients, kindly offering support as the news is heard.

How do we learn how to communicate this information effectively? What are the ethical issues in sharing this information? What cultural considerations might bias us or help us build the relationship?

Articles

• Discussing Prognosis: "How Much Do You Want to Know?" Talking to Patients Who Are Prepared for Explicit Information Anthony L. Back, Robert M. Arnold Journal of Clinical Oncology, Vol 24, No 25 (September 1), 2006: pp. 4209-4213
  
• Necessary Collusion: Prognostic Communication With Advanced Cancer Patients Helft, Paul Journal of Clinical Oncology, Vol 23, No 13 (May 1), 2005: pp. 3146-3150 DOI: 10.1200/JCO.2005.07.003
  
• Bioethics in a different tongue: The case of truth-telling Leslie J. Blackhall , Gelya Frank, Sheila Murphy and Vicki Michel. Journal of Urban Health. Volume 78, Number 1 / March, 2001 DOI: 10.1093/jurban/78.1.59
  
• Truth-telling in discussing prognosis in advanced life-limiting illnesses: a systematic review Hancock K, Clayton JM, Parker SM, Wal der S, Butow PN, Carrick S, Currow D, Ghersi D, Glare P, Hagerty R, Tattersall MH. doi: 10.1177/0269216307080823
  
• Cancer Patient Preferences for Communication of Prognosis in the Metastatic Setting Rebecca G. Hagerty, Phyllis N. Butow, Peter A. Ellis, Elizabeth A. Lobb, Susan Pendlebury, Natasha Leighl, David Goldstein, Sing Kai Lo, Martin H.N. Tattersall Journal of Clinical Oncology, Vol 22, No 9 (May 1), 2004: pp. 1721-1730 DOI: 10.1200/JCO.2004.04.095
  
• Persisting differences in truth telling throughout the world SAVE Antonella Surbone Journal Supportive Care in Cancer Issue Volume 12, Number 3 / March, 2004 DOI 10.1007/s00520-003-0579-9
  

Pediatrics:

• Communication About Prognosis Between Parents and Physicians of Children With Cancer: Parent Preferences and the Impact of Prognostic Information Jennifer W. Mack, Joanne Wolfe, Holcombe E. Grier, Paul D. Cleary, Jane C. Weeks. Journal of Clinical Oncology, Vol 24, No 33 (November 20), 2006: pp. 5265-5270
  

Cross-Cultural:

• The Perception Gap — Race, Religion, and Prognosis in the ICU Mark D. Siegel and Holly G. Prigerson CHEST July 2010 vol. 138 no. 1 8-9 doi: 10.1378/chest.10-0454