Prognostic disclosure in metastatic breast cancer: a scoping review

Prognostic disclosure enables shared decision-making by keeping patients informed about their health and involved in treatment choices. Prognostic uncertainty is prominent in metastatic breast cancer (mBC) and is a known barrier to prognostic disclosure, yet knowledge about prognostic disclosure in mBC has not been systematically mapped.

This scoping review aimed to explore the literature on prognostic disclosure in mBC and highlight research gaps.

We followed Arksey and O'Malley's expanded framework. Electronic databases MEDLINE (via PubMED), Scopus, PsychINFO and CINAHL were systematically searched for peer-reviewed, published journal articles. Results are reported following the PRISMA-ScR guidelines.

The search yielded 1715 articles; ten met the inclusion criteria. Qualitative analysis identified 9 themes: Balancing Truth and Hope; Persistent Gaps Between Patient Informational Needs and Physician Responses; Using the Internet to Find Prognostic Information; the Role of Religious Beliefs; Challenges in Understanding Prognostic Information; Use of Empathy; Health Literacy and Satisfaction with Communication; Potential Harms; Structured Multidisciplinary Disclosure Interventions. Our findings suggest that the needs and preferences of patients with mBC regarding prognostic disclosure are influenced by emotional, psychological, religious, and existential factors, and change during the disease trajectory.

Balancing truth and hope in prognostic disclosure with patients with mBC requires nuanced, emotionally attuned approaches. Clinicians could revisit patients' preferences at disease milestones or decision points. Research is needed to explore patient characteristics predicting prognostic preferences, to facilitate individualized communication, and to elucidate the impact of targeted treatments, immunotherapy, and the associated prognostic uncertainties on prognostic disclosure in mBC.