Talking with Patients about Dying — NEJM

Talking with Patients about Dying — NEJM

To the Editor:

Weeks et al. (Oct. 25 issue)1 raise an important concern that patients with advanced cancers may not understand that chemotherapy is not curative. However, as the authors acknowledge, there are challenges in interpreting patients' expectations on the basis of responses to a single, closed-ended interview item.
Our study on informed consent in early-phase oncology trials may shed light on the extent of these challenges. We found that patients express higher expectations of benefit when the query is framed in terms of personal benefit rather than in terms of a population frequency of a particular benefit.2,3 Furthermore, patients with the greatest optimism regarding the benefit of experimental therapy commonly explain their answer in terms of the importance of expressing a positive attitude, not in terms of their assessment of their actual prognosis.2 Thus, interpretation of patient-survey items must account for the fact that what we think we are asking patients may be different than what patients mean by their responses.