Discussing Progression and Prognosis

Most patients, at one moment or another, would like to know their condition when progression occurs. Questions about prognosis of disease can be answered in different ways—one way is to avoid the question by stating that predicting outcome is very difficult in oncology, and another is to provide statistical information, which indicates a medium survival time in months. This later attitude often does not meet the needs of the patient but the needs of the physician so as to get rid of the problem. A patient-centred way to answer such questions is to try to understand the preoccupations of the patients and what they

Table 6 Informing about progression and prognosis of disease

Try to pick up patients' cues concerning preoccupations about the future

Ask the patient about the aspects and degree of details he/she wishes to know

Avoid contradictory information, assure interdisciplinary agreement

Maintain hope without denying the seriousness of the medical situation

Respect denial and inform significant others about its protecting function

Schedule regular follow-up visits and invite the patient to maintain contact think about the current condition, before exploring what kind of information they would like to receive. While there are patients who feel more in control by obtaining detailed medical information, others like to know if cure or delaying the progression is still possible, without asking questions about what will happen later.

Discussing progression of disease also includes information about the future (see Table 6).

In this phase of the illness it is especially important that the patient receives the same message from all staff members in order to enhance a feeling of coherence and to prevent confusion. This topic is presented in the chapter "Interdisciplinary Communication", by F. Porchet, in this volume. Since progression of disease represents a considerable psychological distress, measures that counteract patient feelings of abandonment are necessary. Beside the trusting relationship a clinician has established with the patient, regular follow-up visits and an invitation to call if there are concerns are beneficial.

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