Nurses Must Help Patients With Late-Stage Cancer Understand Their Prognoses

Better prognostic understanding led to earlier use of palliative care and more DNRs in patients with late-stage cancer.

When treating individuals with late-stage cancer, it is crucial that oncology nurses effectively communicate the patient’s prognosis and establish open communication regarding advanced care planning.

“Early prognostic awareness can improve patients’ and families’ ability to make informed decisions regarding treatment, travel, and finances. The education on disease prognosis allows the patient time to both emotionally and physically prepare for their death,” said Tiffany S. Whetzel, BSN, RN-BC, CNIII, a graduate student at Lubbock Christian University.

Whetzel recently presented her research on prognostic awareness at the 46th Annual ONS Congress.1 She explained that patients with late-stage cancer tend to have relatively low prognostic awareness, and often “hold on to unrealistic hopes of cancer becoming cured, due to the misunderstanding of the prognostic and intentions of treatment.”

A literature review on prognostic awareness found research that stated that 81% of patients with colorectal cancer and 69% of patients with lung cancer did not understand that their treatment was not likely to cure their disease.2

Findings also showed that while less than 20% of patients reported having end-of-life discussions, at least 50% of families said that they had regret about loved one’s end-of-life experience. Advanced care planning was shown to decrease caregiver distress, while earlier palliative care improved patient’ mood, quality of life, coping communication, and prognostic awareness.

“Increased prognostic awareness can have many benefits, such as allowing patients to make more informed end-of-life decisions, reducing aggressive treatment, and improving the patient’s quality of life toward end of life,” Whetzel said.

Whetzel found that factors that hindered discussions about patients’ prognoses included lack of provider time; lack of communication skills; patients with low health literacy and high emotional status.

However, there are interventions that can improve prognostic awareness, like the Heidelberg Milestones Communication Approach.3 This approach focuses on 4 milestone patient-provider conversations at diagnosis, stable disease, progression, and the supportive care phase. Additionally, patients can be given lists of questions that can prompt conversations about their prognosis.

When patients have better prognostic awareness, they tended to be more likely to sign do-not-resuscitate orders and entered palliative care earlier.

“Not only are health care providers responsible for making sure that their patient understands their prognosis, but to make sure that the patient is emotionally supported through the end of life as well,” Whetzel said.

References

1. Whetzel TS. Increased Prognostic Awareness in Terminally Ill Cancer Patients: An Integrated Research Review. Presented at: 46th Annual ONS Congress. April 20, 22, 27, 29, 2021. Virtual

2. Ghandourh WA. Palliative care in cancer: managing patients’ expectations. Journal of Medical Radiation Sciences. August 9, 2016. https://doi.org/10.1002/jmrs.188

3. Bossert J. Wensing M. Thomas M. et al. Implementation of the milestones communication approach for patients with limited prognosis: evaluation of intervention fidelity. BMC Palliative Care. February 2020. DOI: 10.1186/s12904-020-0527-1