肿瘤学家如何传达预后的循证指导很少。 研究预后沟通策略的效果（预后披露与不可预测性沟通与不披露；标准与标准以及最佳情况与标准，最佳情况和最坏情况下的生存情景；基于数字的估计与基于文字的估计）对晚期癌症的预后认知、治疗决策和临终预期。这项实验研究使用了八个脚本化肿瘤咨询视频，仅在预后方面有所不同沟通策略。想象自己是所描述的患者的癌症天真个体在观看一段视频之前和之后完成了调查（n = 1036）。与不可预测或不披露的沟通相比，人们普遍认为在预后披露后一年内死亡的可能性更大（ p<.001），以及基于数字与基于单词的估计之后（p<.001）。与不可预测性或未披露的沟通相比，个人在预后披露后感觉更了解预后以决定治疗 (p<.001)；在沟通不可预测性与不披露之后（p<.001）；以及基于数字和基于文字的估计 (p=.017)。与未披露预后相比，化疗在预后披露后更受青睐 (p=.010)，但在数字估计与基于文字的估计后则较少受青睐 (p<.001)。与不可预测性或未披露的沟通相比，个人在预后披露后对治疗决定更加确定（p<.001）。不存在不同生存情景的影响。没有观察到对临终预期的影响。调节个体特征的证据有限。肿瘤学家是否以及如何讨论预后会影响个体如何看待预后、他们喜欢哪种治疗以及他们对治疗决策的感受。交流数值估计可能会促进对预后的理解和明智的治疗决策。版权所有 © 2024。由 Elsevier Inc. 出版。

Evidence-based guidance for oncologists on how to communicate prognosis is scarce.To investigate the effects of prognostic communication strategies (prognostic disclosure vs. communication of unpredictability vs. non-disclosure; standard vs. standard and best-case vs. standard, best- and worst-case survival scenarios; numerical vs. word-based estimates) on prognostic perceptions, treatment decision-making and end-of-life anticipation in advanced cancer.This experimental study used eight videos of a scripted oncological consultation, varying only in prognostic communication strategies. Cancer-naive individuals, who imagined being the depicted patient, completed surveys before and after watching one video (n=1036).Individuals generally perceived dying within 1 year as more likely after prognostic disclosure, compared to communication of unpredictability or non-disclosure (p<.001), and after numerical versus word-based estimates (p<.001). Individuals felt better informed about prognosis to decide about treatment after prognostic disclosure, compared to communication of unpredictability or non-disclosure (p<.001); after communication of unpredictability versus non-disclosure (p<.001); and after numerical versus word-based estimates (p=.017). Chemotherapy was more often favored after prognostic disclosure versus non-disclosure (p=.010), but less often after numerical versus word-based estimates (p<.001). Individuals felt more certain about the treatment decision after prognostic disclosure, compared to communication of unpredictability or non-disclosure (p<.001). Effects of different survival scenarios were absent. No effects on end-of-life anticipation were observed. Evidence for moderating individual characteristics was limited.If and how oncologists discuss prognosis can influence how individuals perceive prognosis, which treatment they prefer, and how they feel about treatment decisions. Communicating numerical estimates may stimulate prognostic understanding and informed treatment decision-making.Copyright © 2024. Published by Elsevier Inc.