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"The median isn't the message": How to communicate the uncertainties of survival prognoses to cancer patients in a realistic and hopeful way

Geir Kirkeb√łen
European Journal of Cancer Care 2019 April 24, : e13056
This study investigated how doctors communicate the uncertainties of survival prognoses to patients recently diagnosed with life-threatening cancer, and suggests ways to improve this communication. Two hundred thirty-eight Norwegian oncologists and general practitioners (GPs) participated in Study 1. The study included both a scenario and a survey. The scenario asked participants to respond to a hypothetical patient who wanted to know how long (s)he could be expected to live. There were marked differences in responses within both groups, but few differences between the GPs and oncologists. There was a strong reluctance among doctors to provide patients with a prognosis. Even when they were presented with a statistically well-founded right-skewed survival curve, only a small minority provided hope by communicating the variation in survival time. In Study 2, 177 healthy students rated their preferences for different ways of receiving information regarding the uncertainty of a survival prognosis. Participants who received an explicitly described right-skewed survival curve believed that they would feel more hopeful. These participants also obtained a more realistic understanding of the variation in survival than those who did not receive this information. Based on the findings of the two studies and on extant psychological research, the author suggests much-needed guidelines for communicating survival prognoses in a realistic and optimistic way to patients recently diagnosed with life-threatening cancer. In particular, the guidelines emphasise that the doctor explains the often strongly right-skewed variation in survival time, and thereby providing the patient with realistic hope.


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