Patient Perceptions of Oncologist–Patient Communication About Prognosis: Changes From Initial Diagnosis to Cancer Recurrence

Abstract

Cancer recurrence presents oncologists with many challenges, including discussing prognosis. A thematic analysis of patient interviews was conducted to learn more about how this challenge is met by doctors and patients in their communication. Female patients being treated for a cancer recurrence at a comprehensive cancer center (N = 30) were asked to recall how they discussed their prognosis with oncologists when initially diagnosed and when the cancer recurred. All interviews were recorded, transcribed, and thematic analysis applied to patients' remarks concerning prognosis. Following comparison of prognosis quotes identified in the transcript, two primary themes were drawn from the data: communicating optimism at the initial diagnosis; and communicating chronic disease management at recurrence. Three subthemes were also identified in the recurrence communication: managing the new information; ambiguous communication about the prognosis; and the information seeking paradox. Problematic integration theory is offered as an important explanatory mechanism for understanding oncologist-patient communication about prognosis during a cancer recurrence.

Notes

¹Cancer staging is an indicator of cancer severity. Stages 1–4 specify the size and extent of a primary (i.e., first) tumor. Higher numbers indicate more extensive disease. Stage 4 (i.e., metastatic) indicates that the cancer has spread to another organ and is not likely to be cured. Recurrent cancer does not follow the four stages per se; rather, it is most typically referred to as distant (i.e., occurring in distant parts of the body) or regional (i.e., involvement of regional lymph nodes). In both cases it is still considered metastatic disease.

²Some types of breast cancer can recur regionally rather than distantly. It can also recur multiple times, leading us to specify participation criteria for the first recurrence that is also metastatic.

³ Acute typically refers to a brief, severe disease, whereas chronic disease is ongoing and long-lasting.