Most cancer patients say they want all available information about their medical conditions. Yet studies measuring patient knowledge show striking deficiencies in basic understanding, especially about prognostic issues such as rates of treatment success and cure. The proposed study is designed to answer a number of key questions surrounding doctor-patient communication about prognosis: (1) What prognostic information do patients desire; (2) What physician-patient communication strategies lead to more accurate prognostic expectations by patients? and (3) What is the impact on patients of fully understanding their prognoses? Results will help us to understand the best ways of communicating prognostic information to patients, and further will determine whether an accurate understanding of prognosis is helpful or harmful to patients' psychological status. This project will focus on patients with hematologic malignancies such as leukemia, lymphoma, multiple myeloma, and myelodysplastic syndrome since little is known about communication with this patient population. In addition, this population poses different clinical issues than the adjuvant or palliative setting in which most prior work has concentrated. Two hundred and sixty-four patients will be interviewed prior to their first oncology visits, their consultations will be audio-taped, and patients will be interviewed again 1-2 days afterwards and at 3 months to see how specific aspects of the consultation affected them. This study will result in a unique data set that will enable us to plan specific interventions to enhance effective and compassionate doctor-patient communication about prognosis based on empirically observed physician and patient behaviors. In addition, important baseline outcome data will be generated that will be critical for designing future intervention studies. The project works towards the overall goal of enhancing communication, improving patient understanding, and facilitating psychosocial adaptation to life-threatening illness.
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