This study will describe physician-patient communication regarding prognosis and treatment options in Stage IV Non Small Cell Lung Cancer. Lung cancer is currently the leading cause of cancer death in the United States. Metastatic lung cancer is also the paradigmatic example of a disease in which the treatment options carry high toxicity with little life expectancy benefit. Metastatic lung cancer patients who are well informed about life expectancy with and with out treatment may, therefore, realistically choose palliative care over aggressive chemotherapy. ? ? Cancer patients are frequently faced with complex medical decisions that necessitate a reliance on physicians' abilities to distill and communicate scientific data that may inform treatment decisions. Patients with advanced cancer must choose between life-extending therapy and treatment aimed at symptom control and palliation. In order to make this decision it is critical that patients with incurable cancer understand how various treatments affect their quantity and quality of life. Little is known, however, about how information regarding prognosis and the impact of treatment on prognosis is communicated to patients with cancer and little is known about how patients understand what is communicated to them. ? ? We propose to study the content of information that is transmitted, the process by which that communication occurs, and the potential barriers to patient understanding through the analysis of audio tapes of 100 different pairs of oncologist-patient interactions. This data will be correlated with patient's information seeking preferences, understanding of prognosis, and sociodemographic characteristics. Physicians will also be surveyed to assess their perceptions of patient's desire for prognostic information, patient's performance status and sociodemographic information. Based on our analysis of the process and content of communication we will develop and pilot interventions to improve the process of information giving and decision-making in oncology.
