Communication with patients with limited prognosis-an integrative mixed-methods evaluation study.

Area of Science:

• Oncology
• Palliative Care
• Communication Studies

Background:

• Oncological societies recommend continuity of care, specialized communication, and early palliative care integration.
• The Milestone Communication Approach (MCA) was developed to meet these recommendations.
• Previous implementation and evaluation of MCA have been conducted.

Purpose of the Study:

• To explore patient perspectives on why prognosis and advance care planning are rarely discussed.
• To understand the lack of observed differences between MCA and control groups in distress, quality of life, and mood.

Main Methods:

• Mixed-methods design incorporating a pragmatic randomized trial (n=171).
• Qualitative interviews with patients (n=13) and caregivers (n=12).
• Content analysis of milestone conversations (133) and follow-up calls (54), analyzed using a pillar integration process.

Main Results:

• Two key themes emerged: 'approaching prognosis and advance care planning' and 'living with a life-threatening illness'.
• Prognostic information was offered, but patient reactions varied; some patients felt healthy and unprepared for such discussions.
• Patients consistently struggled to maintain quality of life and manage distress.

Conclusions:

• Early attention to patient questions, worries, and needs is vital for adjustment to advanced lung cancer.
• Clinicians must balance informing patients about prognosis with respecting their desire to avoid such information.
• Further research is needed to understand patients' reluctance towards prognostic information to enhance communication strategies.