• Robert Gramling, Kevin Fiscella, Guibo Xing, Michael Hoerger, Paul Duberstein, Sandy Plumb, Supriya Mohile, Joshua J Fenton, Daniel J Tancredi, Richard L Kravitz, and Ronald M Epstein.
• School of Nursing, University of Rochester, Rochester, New York2Division of Palliative Medicine, University of Vermont, Burlington3Department of Family Medicine, University of Vermont, Burlington4Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York5Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, New York6Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York7Division of Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, New York.
• JAMA Oncol. 2016 Nov 1; 2 (11): 1421-1426.

ImportancePatients with advanced cancer often report expectations for survival that differ from their oncologists' expectations. Whether patients know that their survival expectations differ from those of their oncologists remains unknown. This distinction is important because knowingly expressing differences of opinion is important for shared decision making, whereas patients not knowing that their understanding differs from that of their treating physician is a potential marker of inadequate communication.ObjectiveTo describe the prevalence, distribution, and proportion of prognostic discordance that is due to patients' knowingly vs unknowingly expressing an opinion that differs from that of their oncologist.Design, Setting, And ParticipantsCross-sectional study conducted at academic and community oncology practices in Rochester, New York, and Sacramento, California. The sample comprises 236 patients with advanced cancer and their 38 oncologists who participated in a randomized trial of an intervention to improve clinical communication. Participants were enrolled from August 2012 to June 2014 and followed up until October 2015.Main Outcomes And MeasuresWe ascertained discordance by comparing patient and oncologist ratings of 2-year survival probability. For discordant pairs, we determined whether patients knew that their opinions differed from those of their oncologists by asking the patients to report how they believed their oncologists rated their 2-year survival.ResultsAmong the 236 patients (mean [SD] age, 64.5 [11.4] years; 54% female), 161 patient-oncologist survival prognosis ratings (68%; 95% CI, 62%-75%) were discordant. Discordance was substantially more common among nonwhite patients compared with white patients (95% [95% CI, 86%-100%] vs 65% [95% CI, 58%-73%], respectively; P = .03). Among 161 discordant patients, 144 (89%) did not know that their opinions differed from that of their oncologists and nearly all of them (155 of 161 [96%]) were more optimistic than their oncologists.Conclusions And RelevanceIn this study, patient-oncologist discordance about survival prognosis was common and patients rarely knew that their opinions differed from those of their oncologists.

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