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Prognostic Disclosure to Patients with Cancer near the End of Life

Elizabeth B. Lamont, MD, MS; and Nicholas A. Christakis, MD, PhD, MPH
[+] Article, Author, and Disclosure Information

From University of Chicago Medical Center, Chicago, Illinois.

Acknowledgments: The authors thank Tammy Polonsky and Ellena Linden for help in administering the survey and Ron Thisted and Melinda Drum for statistical consultation.

Grant Support: By the Soros Foundation Project on Death in America Faculty Scholars Program (Dr. Christakis), the Robert Wood Johnson Clinical Scholars Program034652 (Dr. Lamont), and the National Institutes of Health (K12 AG-0048-09) (Dr. Lamont).

Requests for Single Reprints: Nicholas A. Christakis, MD, PhD, MPH, University of Chicago Medical Center, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637; e-mail, nchrista@medicine.bsd.uchicago.edu.

Current Author Addresses: Drs. Lamont and Christakis: University of Chicago Medical Center, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637.

Author Contributions: Conception and design: N.A. Christakis.

Analysis and interpretation of the data: E.B. Lamont, N.A. Christakis.

Drafting of the article: E.B. Lamont, N.A. Christakis.

Critical revision of the article for important intellectual content: E.B. Lamont, N.A. Christakis.

Final approval of the article: E.B. Lamont, N.A. Christakis.

Provision of study materials or patients: N.A. Christakis.

Statistical expertise: E.B. Lamont, N.A. Christakis.

Obtaining of funding: E.B. Lamont, N.A. Christakis.

Administrative, technical, or logistic support: N.A. Christakis.

Collection and assembly of data: E.B. Lamont, N.A. Christakis.

Ann Intern Med. 2001;134(12):1096-1105. doi:10.7326/0003-4819-134-12-200106190-00009
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Forty years ago, physicians did not inform most patients with cancer of their diagnoses (12). This practice of nondisclosure is now generally considered out of date, primarily because it may represent physician paternalism that compromises patient autonomy. Indeed, almost all patients with cancer are now informed of their diagnoses (3). Nevertheless, it is not clear how many understand the survival implications, that is, the associated prognosis. Because survival estimates often strongly affect decisions about cancer treatment, especially at the end of life, patients need and often rightly request prognoses when making such decisions (47).

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Grahic Jump Location
Figure 1.
Relationship between formulated and communicated survival.

The communicated survival and the formulated survival, in days, are shown for a cohort of 232 patients at the time of initiation of home-based hospice care. For the remaining 68 patients in our sample of 300, no prognosis would have been communicated. Not all points are visible because some may overlap precisely. The diagonal line represents frank disclosure. Patients above the diagonal line would receive knowingly overestimated survival information, and patients below the diagonal line would receive knowingly underestimated survival information.

Grahic Jump Location
Grahic Jump Location
Figure 2.
Relationship between communicated, formulated, and actual survival.

The differences between actual survival, formulated survival, and communicated survival in 300 terminally ill patients with cancer are shown. The median actual survival was 26 days, the median formulated survival was 75 days, and the median communicated survival was 90 days.

Grahic Jump Location




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Summary for Patients

How Willing Are Doctors To Give Patients with Terminal Cancer Accurate Information about Their Chances of Survival?

The summary below is from the full report titled “Prognostic Disclosure to Patients with Cancer near the End of Life.” It is in the 19 June 2001 issue of Annals of Internal Medicine (volume 134, pages 1096-1105). The authors are EB Lamont and NA Christakis.


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