Recent studies have found that cancer patients retain less than half of what their doctors tell them.
When a doctor tells a patient that he has cancer and has just a year to live, the patient hears practically nothing afterwards.
Anxiety makes it difficult to remember details and the worse the prognosis, the less the patient tends to remember.
Unsurprisingly, that a patient with advanced cancer can leave her oncology appointment thinking she has a set amount of time to live. As she buys a gallon of milk with an expiration date she will think “the doctor gave me a year.”
However, prognoses are almost never that clear-cut.
Physicians play a role in the confusion too. According to several studies, doctors consistently overestimate how long a patient has to lie. One study found that just 20% of physician predictions were accurate in reference to terminally ill patients. 63% were overoptimistic.
Furthermore, if a patient thinks a doctor is doing a good job of communicating with them, they are more likely to be erroneously optimistic about a cure. Unfortunately, this can keep patients from fulfilling key goals before they die.
Prognosis is not an absolute number.
Doctors usually look up data gathered by the National Cancer Institute or the American Cancer Society, of they use their own clinical expertise.
The data is typically given as a median, which is different from an average. So if a patient is told she has a year median survival, it means that half of similar patients will be alive at the end of a year and half will have died. But the median doesn’t take into account health and access to treatments
Doctors often think of the number as a median, but patients understand it as an absolute number. There is a breakdown in communication between the doctor and patient when it comes to the prognostic discussion.
A group of psychiatrists, psychologists and behavioral scientists are training people who treat cancer on how to make the conversation easier and more informative for everyone. Honesty is key.