St. Jude Children's Research Hospital, Memphis, TN, USA.
The University of Texas Southwestern Medical Center, Dallas, TX, USA.
BMC Cancer. 2022 Oct 31;22(1):1109. doi: 10.1186/s12885-022-10190-6.
Most patients with cancer and their caregivers desire honest, clear prognostic communication, yet oncologists often disclose prognosis inconsistently. Prognostic communication becomes even more challenging when disease progression is unclear or equivocal. Presently, oncologist approaches for discussing uncertain disease findings are poorly understood.
In this prospective, longitudinal study, we audio-recorded serial disease reevaluation conversations between children with high-risk cancer, their families, and their primary oncologists over 24 months and conducted content analysis at recorded timepoints when oncologists categorized disease progression as equivocal.
Of the 265 medical discussions recorded across the illness course for 33 patient-parent dyads, a total of 40 recorded discussions took place at equivocal timepoints, comprising > 500 min of medical dialogue. Prognosis talk encompassed < 3% of dialogue and was absent in nearly half of equivocal discussions (17/40, 42.5%). Curability statements were identified in only two conversations. Inductive content analysis of dialogue revealed four distinct patterns for communicating equivocal disease status: (1) up-front reassurance, (2) softening the message, (3) describing possible disease progression without interpretation, (4) expressing uncertainty without discussing the bigger picture.
Oncologists rarely discuss prognosis with children with high-risk cancer and their families at timepoints when disease progression is not definitive. Formal guidance is needed to better support oncologists in navigating uncertainty while sharing honest, person- and family-centered information about prognosis.
大多数癌症患者及其照护者都希望得到诚实、清晰的预后沟通，但肿瘤医生往往不能始终如一地提供预后信息。当疾病进展不明确或存在争议时，预后沟通就变得更加具有挑战性。目前，对于讨论不确定疾病发现的肿瘤医生方法，人们知之甚少。
在这项前瞻性、纵向研究中，我们对 33 名高危癌症患儿及其家庭与他们的主要肿瘤医生之间的一系列疾病再评估对话进行了音频记录，并在肿瘤医生将疾病进展归类为不确定的时间点进行了记录时的内容分析。
在 33 对患儿-家长的 265 次医疗讨论中，共有 40 次讨论发生在不确定的时间点，包含超过 500 分钟的医疗对话。预后讨论仅占对话的<3%，近一半（17/40，42.5%）的不确定讨论中没有预后讨论。仅在两次对话中发现了治愈可能性的陈述。对对话的归纳内容分析揭示了四种不同的沟通不确定疾病状态的模式：（1）预先保证，（2）软化信息，（3）描述可能的疾病进展而不进行解释，（4）表达不确定性而不讨论更大的图景。
当疾病进展不明确时，肿瘤医生很少与患有高危癌症的儿童及其家庭讨论预后。需要有正式的指导，以更好地支持肿瘤医生在分享关于预后的诚实、以患者和家庭为中心的信息时应对不确定性。
