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Prognosis communication for people with head and neck cancer

Analysis of succesfully communicating prognosis for people with head and neck cancer

Analysis of succesfully communicating prognosis for people with head and neck cancer

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Head and neck cancer and its treatments are associated with significant morbidity, mortality and negative impacts on the physical and mental well-being of the patient. For many reasons, the communication of prognosis is recognisably difficult and distressing for the patient and clinician. However, in an era of more informed and involved patients, an emphasis on shared decision-making would suggest the need for more clarity and openness and more skilful professional dialogue.

In this Dutch qualitative single centre descriptive study to explore the communication styles employed, researchers audiotaped and analysed 23 real discussions about treatment options between physicians and patients where questions on prognosis could be reasonably expected to arise.

The average age of the patient participant was 68 years; the majority of patients were male (74%); most patients had a curative treatment plan, with only 13% being ascribed palliative intent treatment. Prognostic information was shared at all consultations.

In contrast to literature suggesting the value of numerical expressions of prognosis, which improve discernment of risk and provide some reassurance of involvement with the process of decision-making, actual quantitative approaches to the provision of predictive information, such as the use of numbers and statistics, were used infrequently (seven interviews, 13 quotations, 5.9% overall).

A qualitative means and method of providing information was given in most situations, using an assortment of approaches, including positive framing, where positive language, such as ‘luckily for you’ would be used; or negative framing, where less optimistic elements could be stressed, such as ‘a big operation with a lot of risk’.

The authors note that this might adversely affect the patient’s comprehension of the information being provided.

Dronkers, EAC et al (2018) Communication of prognosis in head and neck cancer patients: a descriptive qualitative analysis. Oral Oncology. doi: 10.1016/j.oraloncology.2018.07.014

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