Prognostic discussions in patients with advanced lymphoma: Characteristics and challenges

Prognostic discussions are critical in the care of patients with advanced lymphoma, given the disease's complexity, rapidly evolving treatments, and shifting potential for cure. However, previous research has paid limited attention to how these discussions unfold from both patient and clinician perspectives, particularly in the context of early conversations. The current study sought to identify key experiences that inform improvements in clinician communication and patient understanding of prognosis for patients with advanced lymphoma.

We conducted a qualitative study from July 2023 to June 2024 with 19 patients diagnosed with advanced lymphoma and 3 oncologists. Semi-structured interview transcripts were analyzed using thematic content analysis, and emergent themes were identified through consensus among a trained coding team.

Two primary themes emerged. First, patients recalled early prognostic conversations as highly focused on curative intent. Second, oncologists cited incomplete diagnostic data and concerns about overwhelming patients as reasons for limiting early discussions, often delaying deeper prognostic conversations. Clinicians reported tension between maintaining patient hope and providing comprehensive information about disease trajectory and treatment uncertainty.

Findings highlight a need for communication strategies that balance hope with realism in early prognostic discussions for patients with advanced lymphoma. Oncologists may benefit from structured, evidence-based guidance to manage information delivery over time, particularly in the face of diagnostic ambiguity. Future research should prioritize inclusive sampling and explore timing and content of ongoing prognostic discussions to better support informed decision-making and goal-concordant care.