Bridging the communication gap between oncologists and patients receiving palliative therapies

The discussion of prognosis is a regular component of oncology practice. When the prognosis is poor, the disclosure can be difficult for both patients and physicians alike. In a recent article by Chen et al., stage IIIB and IV lung cancer patients were surveyed on their beliefs about radiotherapy they were receiving. A significant proportion of patients expressed the belief that radiotherapy, which they were receiving purely with palliative intent, was likely to cure their cancer. Misunderstanding the goals of treatment can have important consequences with respect to informed decision-making and end-of-life planning. There are likely many factors contributing to this misunderstanding, both from the perspective of the patient as well as the physician. Discussing incurable disease in a clear, honest manner without taking away hope can be very challenging for the physician. Even when done well, patients often do not hear or completely understand the message. Focusing on active treatment may in fact perpetuate the patient's belief that they can be cured. In this article, some of the factors contributing to inaccurate beliefs are discussed. Awareness of the issue, and approaching the patient in a somewhat different manner when disclosing prognosis, may help patients to develop more appropriate beliefs about their disease and treatment. Ultimately the goal is for patients to make decisions that align with their beliefs and values, which can only be done if they have clear understanding of prognosis.