Cancer Patient Optimism Negatively Impacts Physician Judgements

Optimism among patients with terminal cancer is a psychological state that can become contagious and have a negative influence over their physicians’ prognostic judgements, according to researchers from Larner College of Medicine at the University of Vermont who published their findings in Psycho-Oncology.

In this direct-observation, multisite cohort study, researchers evaluated and audio-recorded 189 patients with advanced cancer who were consulted about palliative care. Patients were enrolled from Rochester Medical Center in New York and University of California, San Francisco, representing two large U.S. academic medical facilities. All patients were English-speaking, older than 21 years, diagnosed with metastatic non-hematologic cancer, did not have an exclusively comfort-oriented plan of care documented at the time of referral, and consented to inclusion. Patients self-reported their level of optimism as well as their prognosis expectations prior to palliative consultation, while clinicians rated their survival expectations for patients subsequent to their initial meeting. Patient mortality in this study was tracked over a six-month duration.

Optimism Exerts an “Unforeseen Influence”

Results of the study suggest in a dose-response relation that an association exists between patient optimism and clinical overestimation of their survival prognosis, with clinicians approximately three times more likely to overestimate the survival duration of a patient exhibiting both high traits of optimism and a high optimistic rating of their survival when juxtaposed to patients who displayed neither (odds ratio [OR] = 2.95; 95% CI, 1.24-7.02). This correlation was not diminished by adjustment for age, sex, race, education, financial or functional status, quality of life, nor white blood cell count (OR=3.45; 95% CI, 1.24-9.66). Moreover, the association was not attenuated by random effects of the clinician (OR=3.01; 95% CI, 1.21-7.49), nor by the exclusion of 30 participants with censored observation time (OR=3.71; 95% CI, 1.44-9.59).

“Estimating prognosis is an important clinical study,” authors wrote. “Overestimation of survival time is common, and these errors in judgement can prevent patients from making timely decisions about their end-of-life care.”

The authors noted that their findings “suggest that patient-level optimism might exert an unforeseen influence over palliative care clinicians’ prognostic judgments,” adding that “if so, then raising clinician awareness about these effects and including debiasing steps in prognostication skills training may lead to more accurate estimates.”

Moreover, the authors said that “further research is necessary to confirm these findings and to understand the factors underlying this influence on clinical judgement, especially those that might be mutable.”