How long do I have? Observational study on communication about life expectancy with advanced cancer patients

Objective: To examine how communication about life expectancy is initiated in consultations about palliative chemotherapy, and what prognostic information is presented. Methods: Patients with advanced cancer (n = 41) with a median life expectancy < 1 year and oncologists (n = 6) and oncologists-in-training (n = 7) meeting with them in consultations (n = 62) to discuss palliative chemotherapy were included. Verbatim transcripts of audio-recorded consultations were analyzed using MAXqda10. Results: Life expectancy was addressed in 19 of 62 of the consultations. In all cases, patients took the initiative, most often through direct questions. Estimates were provided in 12 consultations in various formats: the likelihood of experiencing a significant event, point estimates or general time scales of months to years, often with an emphasis on the years. The indeterminacy of estimates was consistently stressed. Also their potential inadequacy was regularly addressed, often by describing beneficial prognostic predictors for the specific patient. Oncologists did not address the reliability or precision of estimates. Conclusion: Oncologists did not initiate talk about life expectancy, they used different formats, emphasized the positive and stressed unpredictability, yet not ambiguity of estimates. Practice implications: Prognostic communication should be part of the medical curriculum. Further research should address the effect of different formats of information provision. (C) 2017 Elsevier B.V. All rights reserved.