Purpose Some research has suggested that discussion of prognosis can disrupt the patient-physician relationship. This study assessed whether physician discussion of prognosis is associated with detrimental changes in measures of the strength of the patient-physician relationship. Methods This was a longitudinal cohort study of 265 adult patients with advanced cancer who visited 38 oncologists within community- and hospital-based cancer clinics in Western New York and Northern California. Prognostic discussion was assessed by coding transcribed audio-recorded visits using the Prognostic and Treatment Choices (PTCC) scale and by patient survey at 3 months after the clinic visit. Changes in the strength of the patient-physician relationship were computed as differences in patient responses to The Human Connection and the Perceived Efficacy in Patient-Physician Interactions scales from baseline to 2 to 7 days and 3 months after the clinic visit. Results Prognostic discussion was not associated with a temporal decline in either measure. Indeed, a one-unit increase in PTCC during the audio-recorded visit was associated with improvement in The Human Connection scale at 2 to 7 days after the visit (parameter estimate, 0.10; 95% CI, -0.02 to 0.23) and 3 months after the visit (parameter estimate, 0.18; 95% CI, 0.02 to 0.35) relative to baseline. Standardized effect sizes (SES) associated with an increase of two standard deviations in the PTCC at each time point were consistent with small beneficial effects (SES, 0.14 [95% CI, -0.02 to 0.29] at 2 to 7 days; SES, 0.24 [95% CI, 0.02 to 0.45] at 3 months), and lower bounds of CIs indicated that substantial detrimental effects of prognostic discussion were unlikely. Conclusion Prognostic discussion is not intrinsically harmful to the patient-physician relationship and may even strengthen the therapeutic alliance between patients and oncologists.

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预后讨论对医患关系的影响：前瞻性队列研究

目的 一些研究表明，对预后的讨论会破坏医患关系。该研究评估了医生对预后的讨论是否与患者与医生关系强度的测量值的有害变化有关。方法 这是一项纵向队列研究，纳入了 265 名成年晚期癌症患者，他们访问了纽约西部和北加利福尼亚州社区和医院癌症诊所的 38 名肿瘤学家。预后讨论通过使用预后和治疗选择 (PTCC) 量表对转录的录音访问进行编码，并在临床访问后 3 个月通过患者调查进行评估。患者-医生关系强度的变化计算为患者对“人际关系”和“患者-医生互动中的感知疗效”量表从基线到诊所访问后 2 至 7 天和 3 个月的反应差异。结果 预后讨论与任一指标的时间下降无关。事实上，在录音访问期间 PTCC 增加一个单位与访问后 2 至 7 天（参数估计值，0.10；95% CI，-0.02 至 0.23）和 3 个月时人际关系量表的改善有关就诊后（参数估计值，0.18；95% CI，0.02 至 0.35）相对于基线。与每个时间点 PTCC 的两个标准偏差增加相关的标准化效应量 (SES) 与小的有益效应一致（SES，0.14 [95% CI，-0.02 到 0.29] 在 2 到 7 天；SES，0.24 [95% CI，0.02 至 0.45] 在 3 个月），并且 CI 的下限表明预后讨论不太可能产生实质性的不利影响。结论 预后讨论本质上不会损害医患关系，甚至可能加强患者与肿瘤学家之间的治疗联盟。