NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia.
Intern Med J. 2020 Dec;50(12):1492-1499. doi: 10.1111/imj.14739.
People with incurable cancer require information about their prognosis to make informed decisions about their future.
To determine the frequency, form and documentation of prognostic discussions between oncologists and their patients with incurable cancer.
We surveyed medical oncologists in Australia and New Zealand about their practices communicating prognosis.
A total of 206 medical oncologists completed the survey. Respondent characteristics were: median age 40 years (range 27-75), female 51%, trainee 22%; and 71% had completed specific training on communicating prognosis. Respondents reported discussing prognosis with a patient a median of 10 times per month (interquartile range 4-15); 88% reported explaining that 'the cancer is incurable' to all their patients with incurable cancer and 84% reported always or usually providing a quantitative estimate of survival time. The preferred method for explaining expected survival time (EST) was providing 'multiple ranges of time with probabilities, for example best-case, typical and worst-case scenarios' (52% of respondents). The most frequently reported barriers to discussing EST were: 'family members requesting that prognostic information not be discussed' (57% of respondents), and 'not knowing the EST' (46% of respondents). Twenty percent reported always documenting prognostic discussions and the EST in the patient's medical record, and 11% reported always documenting this information in their letters to other doctors.
Most oncologists reported providing quantitative estimates of EST to their patients with incurable cancer, but very few reported documenting this information. Methods to help oncologists estimate, explain and document survival time are needed to improve communication of prognosis.
患有绝症的人需要了解自己的预后信息，以便就未来做出明智的决策。
确定绝症患者的肿瘤医生与其进行预后讨论的频率、形式和记录情况。
我们调查了澳大利亚和新西兰的肿瘤医生在预后沟通方面的实践情况。
共有 206 名肿瘤医生完成了这项调查。受访者的特征为：中位年龄 40 岁（范围 27-75 岁），女性占 51%，实习生占 22%；71%的人接受过专门的预后沟通培训。受访者报告称，每月中位数讨论 10 次与患者的预后情况（四分位距 4-15）；88%的人报告向所有患有绝症的患者解释“癌症是无法治愈的”，84%的人报告始终或通常提供生存时间的定量估计。解释预期生存时间（EST）的首选方法是提供“带有概率的多个时间范围，例如最佳情况、典型情况和最差情况”（52%的受访者）。讨论 EST 时最常报告的障碍包括：“家属要求不讨论预后信息”（57%的受访者）和“不知道 EST”（46%的受访者）。20%的受访者报告始终将预后讨论和 EST 记录在患者的病历中，11%的受访者报告始终将这些信息记录在给其他医生的信中。
大多数肿瘤医生报告向患有绝症的患者提供 EST 的定量估计，但很少有医生报告记录这些信息。需要有方法帮助肿瘤医生估计、解释和记录生存时间，以改善预后沟通。
