Discord With Doctor Can Hurt Prognosis
Caregivers urged to help patients talk to their medical team

(HealthDay News) -- Cancer patients don't always agree with their doctors about how well they're battling the disease. Now, research suggests that such conflicts can bode ill for a patient's prognosis.

Investigators at Oregon Health & Science University in Portland found that people with advanced disease have a higher risk of dying when they disagree with their physician about their physical and nutritional status.

"Patients disagreed with their clinicians greater than 50 percent of the time," said study author Dr. Ian Schnadig, a fellow in hematology and medical oncology at the Oregon university.

Overall, doctors tended to rate their patients higher than the patients rated themselves, the study found.

On the other hand, agreeing with the doctor doesn't necessarily mean that a patient's chances of survival will increase. "But there may be some communication gap that could lead to a bad prognosis," noted Ted Gansler, director of medical content at the American Cancer Society.

The research findings were presented at a meeting of the American Society of Clinical Oncology.

For the study, investigators assessed what they called the "performance status" and nutritional status of 1,636 people with advanced colorectal or lung cancer. Performance status is a way of characterizing a patient's well-being. Patients are scored based on how the disease affects their ability to carry out daily activities and their prognosis.

People who were unable to work before their retirement were more likely to disagree with their physician. Having less than a high school education and being depressed more than half of the time also predicted patient-doctor discord.

"We feel it's important to bring patient and clinician assessments about performance status and nutrition into line with one another," Schnadig said. "This is important for developing tools or mechanisms to formally assess patient reports and bring them into line with clinicians."

Caregivers can help bridge the communications gap by preparing the people they're taking care of for visits to the doctor and by participating in the conversation. The National Cancer Institute suggests:

• Make a list of questions and concerns. List the most important questions first.
• If you and the patient have a lot to talk about with the doctor, ask whether a longer appointment can be scheduled (check on fees for this) or whether you can talk to the doctor by phone if there are further questions. (Perhaps a nurse or others on staff can be of help.)
• Before the visit, discuss with the patient the possibility that the information given could be different than what you both expect.
• If you don't like how a question was answered, ask the doctor for further explanation to help you understand.
• Talk with the doctor about any medical advice you've read or received from others to make sure it's valid and does not conflict with what the doctor has told the patient.
• If a concern is not being addressed, ask the question in a different way. This might help the doctor better understand your concern.
• Take notes or ask if you can tape-record the visit.
• Remember that the patient has the right to change doctors if he or she feels that needs aren't being addressed.

On the Web

To learn more about understanding a patient's prognosis, visit the National Cancer Institute.

SOURCES: HealthDay News ; Ted Gansler, M.D., director of medical content, American Cancer Society, Atlanta; Ian Schnadig, M.D., fellow in hematology and medical oncology, Cancer Institute, Oregon Health & Science University, Portland, Ore.; June 5, 2007, presentation, American Society of Clinical Oncology annual meeting, Chicago; National Cancer Institute (www.cancer.gov)
Author: Karen Pallarito
Publication Date: June 30, 2008
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