Communicating Diagnosis and Prognosis to Patients with Cancer: Guidance for Healthcare Professionals: Integrated Models for Prognostication

I found this article to be particularly interesting to me so I decided to share. According to this article it is estimated that the majority of physicians tend to be overly optimistic to patients when it comes to the survival time after prognosis with a cancer. When patients come to someone in the medical profession, it is up us to give as accurate of an estimate of prognosis as we can when the patient requests it. Studies have shown this can help patients to enter programs such as hospice sooner rather than later. Hospice has been defined in some states as life expectancy of 6 months or less if the terminal illness runs its course, and it is determined by the attending physician and the hospital medical director. This article also gives us a 6 step protocol for communicating effectively and provides us with a tool for clarification of the diagnosis and prognosis. SPIKES is S: Setting (getting started), P: Perception (what does the patient know?), I: Invitation (how much does the patient want to know?), K: Knowledge (share the information), E: Emotion (respond to feelings) and S: Subsequent (plan next steps and follow up).

This article also recommended making a partnership with your patient and the family caregiver. Allow them to be involved in the patient’s decision making process regarding his/her care as this allows them to actively participate in the patient’s care plan. It was shown that when a medical professional tries to “soften the blow” this can leave a lack of understanding of significance in the message to the patient, our goal is to communicate effectively so that the patient may understand the importance of what we are conveying to them. As medical professionals we must also help to clarify terminology with our patients and their families to further help cement their understanding of their prognosis and diagnosis, and most importantly we need to be sure that not always does a response to a treatment relate to a cure.


Linda Emanuel, M. P., Frank D. Ferris, M. F., Charles F. von Gunten, M. P., & Jaime H. Von Roenn, M. (2011, January 7). Medscape News Oncology. Retrieved April 7, 2011, from Medscape: (Audria Herrera)

Metastatic Cancer, Unknown Primary Site
Also known as Cancer of Unknown Primary Origin (CUP), metastatic cancer is detremental. Investigations have failed to show the primary origin of people with metastatic cancer who have been undiagnosed with cancer who have advanced this far or this being the first time of recognition. This incidence in the United States is unknown and severly underreported and true incidence ranges from 2 - 6%. In 15-25% of these cases, autopsy will not reveal a firm diagnosis, or place of origin. This is huge because the primary site of cancer, or origin, determines the course of treatment and prognosis of the patient, which now relates to what Audria has said.

Metastatic cancer of this nature can truly only lead to palliative measures, such as hospice, home hospice, and relieving the pain and tackling clinical manifestations (signs/symptoms).

This article speaks to the health promotion aspect of nursing. Taking preventative measures to screen at annual exams for those at risk may provide earlier diagnosis which broadens the scope of treatment.


Winston W. Tan, M. (2009, March 4). Metastatic Cancer, Unknown Primary Site. Retrieved April 8, 2011, from MedScape: (Greg Volz)

Cancer Quest. (2007, July 30). Metastasis. Retrieved April 8, 2011, from Youtube:

Video and Article by Greg Volz