1 Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
2 Harvard Medical School, Boston, Massachusetts.
J Palliat Med. 2019 Jun;22(6):677-684. doi: 10.1089/jpm.2018.0441. Epub 2019 Mar 23.
Although blood cancers are accompanied by a high level of prognostic uncertainty, little is known about when and how hematologic oncologists discuss prognosis. Characterize reported practices and predictors of prognostic discussions for a cohort of hematologic oncologists. Cross-sectional mailed survey in 2015. U.S.-based hematologic oncologists providing clinical care for adult patients with blood cancers. We conducted univariable and multivariable analyses assessing the association of clinician characteristics with reported frequency of initiation of prognostic discussions, type of terminology used, and whether prognosis is readdressed. We received 349 surveys (response rate = 57.3%). The majority of respondents (60.3%) reported conducting prognostic discussions with "most" (>95%) of their patients. More than half (56.8%) preferred general/qualitative rather than specific/numeric terms when discussing prognosis. Although 91.3% reported that they typically first initiate prognostic discussions at diagnosis, 17.7% reported routinely never readdressing prognosis or waiting until death is imminent to revisit the topic. Hematologic oncologists with ≤15 years since medical school graduation (odds ratio [OR] 0.51; confidence interval (95% CI) 0.30-0.88) and those who considered prognostic uncertainty a barrier to quality end-of-life care (OR 0.57; 95% CI 0.35-0.90) had significantly lower odds of discussing prognosis with "most" patients. Although the majority of hematologic oncologists reported discussing prognosis with their patients, most prefer general/qualitative terms. Moreover, even though prognosis evolves during the disease course, nearly one in five reported never readdressing prognosis or only doing so near death. These findings suggest the need for structured interventions to improve prognostic communication for patients with blood cancers.
尽管血液癌症伴随着高度的预后不确定性，但人们对血液肿瘤学家何时以及如何讨论预后知之甚少。本研究旨在描述一组血液肿瘤学家报告的实践情况和预测因素，并探讨预后讨论的预测因素。这是一项 2015 年进行的横断面邮寄调查。调查对象为在美国为成人血液癌症患者提供临床护理的血液肿瘤学家。我们进行了单变量和多变量分析，以评估临床医生特征与报告的预后讨论起始频率、使用术语类型以及是否重新评估预后之间的关联。我们共收到 349 份调查问卷（应答率为 57.3%）。大多数受访者（60.3%）报告说，他们会与“大多数”（>95%）患者进行预后讨论。超过一半（56.8%）的受访者表示，在讨论预后时更喜欢使用一般/定性而非具体/数值术语。尽管 91.3%的受访者表示他们通常在诊断时首次开始讨论预后，但 17.7%的受访者表示他们通常不会重新评估预后，或者等到死亡临近时才重新讨论这个话题。医学院毕业时间≤15 年的血液肿瘤学家（比值比 [OR] 0.51；95%置信区间 [CI] 0.30-0.88）和认为预后不确定性是高质量临终关怀障碍的医生（OR 0.57；95%CI 0.35-0.90）与“大多数”患者讨论预后的可能性显著较低。尽管大多数血液肿瘤学家报告与患者讨论了预后，但大多数人更喜欢使用一般/定性术语。此外，尽管预后在疾病过程中会发生变化，但近五分之一的受访者表示从未重新评估过预后，或者只有在临近死亡时才会重新评估。这些发现表明需要进行结构化干预，以改善血液癌症患者的预后沟通。
