Journal of Oncology Practice: Why Patients Misunderstand Prognosis

Many patients with advanced cancer believe their treatment is working—even when it’s not. So where does that disconnect come from?

This study breaks down real conversations between oncologists and patients and finds a consistent pattern: very little time is spent actually discussing scan results and what they mean. Instead, conversations quickly pivot to treatment decisions.

The most compelling part? A surprisingly simple question—“Would you like to talk about what this means?”—could change everything. If you care about clarity, shared decision-making, or just better conversations in healthcare, this one is worth your time.

Abstract

Introduction:

Patients with incurable cancer have poor prognostic awareness. We present a detailed analysis of the dialogue between oncologists and patients in conversations with prognostic implications.

Methods:

A total of 128 audio-recorded encounters from a large multisite trial were obtained, and 64 involved scan results. We used conversation analysis, a qualitative method for studying human interaction, to analyze typical patterns and conversational devices.

Results:

Four components consistently occurred in sequential order: symptom-talk, scan-talk, treatment-talk, and logistic-talk. Six of the encounters (19%) were identified as good news, 15 (45%) as stable news, and 12 (36%) as bad news. The visit duration varied by the type of news: good, 15 minutes (07:00-29:00); stable, 17 minutes (07:00-41:00); and bad, 20 minutes (07:00-28:00). Conversational devices were common, appearing in half of recordings. Treatment-talk occupied 50% of bad-news encounters, 31% of good-news encounters, and 19% of stable-news encounters. Scan-talk occupied less than 10% of all conversations. There were only four instances of frank prognosis discussion.

Conclusion:

Oncologists and patients are complicit in constructing the typical encounter. Oncologists spend little time discussing scan results and the prognostic implications in favor of treatment-related talk. Conversational devices routinely help transition from scan-talk to detailed discussions about treatment options. We observed an opportunity to create prognosis-talk after scan-talk with a new conversational device, the question “Would you like to talk about what this means?” as the oncologist seeks permission to disclose prognostic information while ceding control to the patient.