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Prognostic disclosure in oncology - current communication models: a scoping review
  1. Julie Rachel Bloom1,
  2. Deborah Catherine Marshall1,
  3. Carlos Rodriguez-Russo1,
  4. Emily Martin2,
  5. Joshua Adam Jones3 and
  6. Kavita Vyas Dharmarajan1
  1. 1 Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  2. 2 Palliative Care Program, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
  3. 3 Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Julie Rachel Bloom, Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; julie.bloom2{at}


Background Prognostic disclosure is essential to informed decision making in oncology, yet many oncologists are unsure how to successfully facilitate this discussion. This scoping review determines what prognostic communication models exist, compares and contrasts these models, and explores the supporting evidence.

Method A protocol was created for this study using the Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols extension for Scoping Reviews. Comprehensive literature searches of electronic databases MEDLINE, EMBASE, PsycINFO and Cochrane CENTRAL were executed to identify relevant publications between 1971 and 2020.

Results In total, 1532 articles were identified, of which 78 met inclusion criteria and contained 5 communication models. Three of these have been validated in randomised controlled trials (the Serious Illness Conversation Guide, the Four Habits Model and the ADAPT acronym) and have demonstrated improved objective communication measures and patient reported outcomes. All three models emphasise the importance of exploring patients’ illness understanding and treatment preferences, communicating prognosis and responding to emotion.

Conclusion Communicating prognostic estimates is a core competency skill in advanced cancer care. This scoping review highlights available communication models and identifies areas in need of further assessment. Such areas include how to maintain learnt communication skills for lifelong practice, how to assess patient and caregiver understanding during and after these conversations, and how to best scale these protocols at the institutional and national levels.

  • communication
  • psychological care
  • supportive care
  • education and training
  • prognosis

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  • Twitter @JulBloom, @emilyjeanmartin

  • Presented at 2021 ASCO Annual Meeting

  • Contributors JRB conceived and designed the analysis, collected data, performed the analysis, wrote scientific paper and oversaw submission process; she is guarantor of overall content. DCM collected data, performed analysis, and was responsible for critical review of the manuscript. CR-R assisted in the review of data and critical review of the manuscript. EM assisted in scoping review analysis, concept design, and manuscript review. JAJ assisted in scoping review analysis and editing of manuscript. KVD assisted in overall concept refinement and manuscript review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.