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In July 2012, two physicians (Dr. Jennifern W. Mack and Dr. Thomas J. Smith) published an essay in the Journal of Clinical Oncology entitled, "Reasons Why Physicians Do Not Have Discussions About Poor Prognosis, Why It Matters, and What Can Be Improved." In their essay, they identify the five (misconceived) reasons and suggest that physicians support each other in having difficult conversations with patients about their prognosis.
1. It Will Make People Depressed
Not true. And the research proves it. Most people---90% in most recent surveys of patients with cancer---want to know their prognosis. In the 2008 "Coping with Cancer" Study, patients who reported having end of life discussions had no higher rates of depression or worry.
The essayists suggest that physicians who ask "What do you know about your illness" and "What do you want to know?" allow patients to express their own wishes about the information they want.
2. It Will Take Away Hope
Not true. Evidence suggests that hope is maintained even with truthful discussions that teach the patient that there is no chance of cure. Physician honesty, particularly with difficult news, may actually help patients to feel more hopeful. The authors suggest that hope is "derived not from prognostic disclosure but rather from the caring patient-physician relationship."
3. We Don't Really Know A Patient's Prognosis
True, but according to the essay, oncologists are often able to formulate a reasonable prognosis or a range of possible outcomes that can bring the patient's understanding closer to the truth.
Though no one knows precisely how long a patient has to live, physicians can engage patients when discussing prognosis by asking "Can you tell me what you are taking away from this conversation?"
4. Talking About Prognosis is not Culturally Appropriate
Not true. It is true that patients of different ethnic and cultural backgrounds often have different preferences for information, but that should not dictate communication with individual patients.
The authors suggest that physicians who want to know their patients' preferences for prognostic information should ask!
5. We Do Not Like to Have These Discussions
Bingo. It's hard to break bad news. No one likes that job. It's stressful, emotionally draining, and when you care about your patients, or have long-term relationships with them, it's particularly hard.
The authors believe that having difficult conversations DO matter---it can improve care, give patients more realistic choices and reduce the rising cost of care. And so do we.
Patients deserve the right to know their prognosis because it supports their ability to make decisions that are right for them.
If you find yourself involved or supporting such a conversation, think about that, please. | 
