The Effect of Prognostic Communication on Patient Outcomes in Palliative Cancer Care: a Systematic Review

Authors

Naomi C. van der Velden, Department of Medical Psychology, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. n.c.vandervelden@amsterdamumc.nl.
Maartje C. Meijers, Department of Medical Psychology, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Paul K. J. Han, Maine Medical Center Research InstituteFollow
Hanneke W. van Laarhoven, Cancer Center Amsterdam, Amsterdam, The Netherlands.
Ellen M. Smets, Department of Medical Psychology, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Inge Henselmans, Department of Medical Psychology, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.

Document Type

Article

Publication Date

4-23-2020

Institution/Department

MaineHealth Institute for Research, Oncology

Journal Title

Current treatment options in oncology

MeSH Headings

Clinical Decision-Making; Communication; Disease Management; Humans; Neoplasms (diagnosis, epidemiology, psychology, therapy); Outcome Assessment, Health Care; Palliative Care (methods, psychology); Physician-Patient Relations; Prognosis; Truth Disclosure

Abstract

BACKGROUND: While prognostic information is considered important for treatment decision-making, physicians struggle to communicate prognosis to advanced cancer patients. This systematic review aimed to offer up-to-date, evidence-based guidance on prognostic communication in palliative oncology. METHODS: PubMed and PsycInfo were searched until September 2019 for literature on the association between prognostic disclosure (strategies) and patient outcomes in palliative cancer care, and its moderators. Methodological quality was reported. RESULTS: Eighteen studies were included. Concerning prognostic disclosure, results revealed a positive association with patients' prognostic awareness. Findings showed no or positive associations between prognostic disclosure and the physician-patient relationship or the discussion of care preferences. Evidence for an association with the documentation of care preferences or physical outcomes was lacking. Findings on the emotional consequences of prognostic disclosure were multifaceted. Concerning disclosure strategies, affective communication seemingly reduced patients' physiological arousal and improved perceived physician's support. Affective and explicit communication showed no or beneficial effects on patients' psychological well-being and satisfaction. Communicating multiple survival scenarios improved prognostic understanding. Physicians displaying expertise, positivity and collaboration fostered hope. Evidence on demographic, clinical and personality factors moderating the effect of prognostic communication was weak. CONCLUSION: If preferred by patients, physicians could disclose prognosis using sensible strategies. The combination of explicit and affective communication, multiple survival scenarios and expert, positive, collaborative behaviour likely benefits most patients. Still, more evidence is needed, and tailoring communication to individual patients is warranted. IMPLICATIONS: Future research should examine the effect of prognostic communication on psychological well-being over time and treatment decision-making, and focus on individualising care.

First Page

40

Recommended Citation

van der Velden NCA, Meijers MC, Han PKJ, van Laarhoven HWM, Smets EMA, Henselmans I. The Effect of Prognostic Communication on Patient Outcomes in Palliative Cancer Care: a Systematic Review. Curr Treat Options Oncol. 2020;21(5):40. Published 2020 Apr 23. doi:10.1007/s11864-020-00742-y