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Discussing Prognosis: Balancing Hope and Realism

Campbell, Toby C. MD*; Carey, Elise C. MD; Jackson, Vicki A. MD; Saraiya, Biren MD§; Yang, Holly B. MD; Back, Anthony L. MD; Arnold, Robert M. MD#

doi: 10.1097/PPO.0b013e3181f30e07
Special Issue on the Role of the Oncologist in Palliative Care

"How much time do I have?" A patient's question about his/her life expectancy is among the most difficult of conversation topics. Oncologists, often with very little training in communication, routinely handle these requests for sensitive information. Oncologists are aware of the emotional weight surrounding a prognosis discussion: answering a prognosis question poorly can damage both a patient's sense of hope and the relationship with his/her physician. Conversely, when handled well, the discussion can affirm the relationship, build trust, and leave the patient feeling hopeful. Our review presents clinicians with a practical approach to handling prognosis discussions by dealing with 4 critical issues. First, we review what information should be conveyed about a patient's prognosis. Next, we provide tools to help the oncologist deal with a patient's emotional reaction. Then, we provide a framework for the discussion that helps preserve a patient's hope despite a poor prognosis. Finally, we address the impact on the physician and provide some suggestions for dealing with our own emotional reactions.

From the *University of Wisconsin School of Medicine and Public Health, Madison, WI; †May Clinic, Rochester, NY; ‡Massachusetts General Hospital, Boston, MA; §Robert Wood Johnson University Hospital, New Brunswick, NJ; ∥San Diego Hospice, San Diego, CA; ¶University of Washington, Seattle, WA; and #the University of Pittsburgh Medical Center, Pittsburgh, PA.

Reprints: Toby C. Campbell, MD, Health Sciences Learning Center, 750 Highland Ave, Madison, WI 53705. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.