Abstract

Because disease diagnosis and prognosis affect the decisions that patients make when creating advance directives, an understanding of one's diagnosis is important for successful advance care planning. Yet often there exists a wide disparity between physician and patient understanding of the patient's disease, making the goal of shared decision-making difficult to achieve. This study examined the extent to which patients with advanced cancer agree with their physicians regarding their cancer diagnoses prior to engaging in advance care planning and explored variables that might correlate with the degree of patient-physician concordance. 150 patients with a diagnosis of cancer and life expectancy of 1-2 years or less completed a questionnaire on their diagnosis before they engaged in creation of an advanced directive. The physician-designated diagnosis was identified for each patient via chart-review. Patient-physician agreement on diagnosis was coded and concordance rates were expressed in percentages. The majority of patients (62.2%) were in exact concordance with their physicians regarding their diagnosis; 24.3% were in partial agreement, with the patient missing part of the diagnosis; 9.5% were in partial agreement, with the physician missing part of the patient-reported diagnosis; and only 4.1% did not agree with their physicians on diagnosis. No correlation was found between patient-physician concordance rates and age, education level, or comfort with computers; nor was a higher degrees of concordance correlated with having received radiation therapy, which might have been expected due to the greater number of hospital visits and opportunities for reinforcement of information.