Table 5 Patterns of prognostic communication in equivocal discussions

Up-front reassurance

Opening the conversation and/or repeatedly stating that the patient is doing well or okay despite equivocal results

• “We have good news.”

• “I don’t think [this is disease]. Very likely, it is not.”

Softening the message

Use of modifiers to soften the message about possible disease progression

• “Let me tell you what I found, I don’t want you to start freaking out…everything looks pretty stable on the PET scan, ok there is a very, very, very, tiny, small area on the left femur and a very small area on the right knee, in retrospect I think they were there before, so I am not very worried about them.”

• “It’s not changing by leaps and bounds; it’s changing very slowly over time. It’s gotten just a little incrementally slightly bigger since the last time we looked at it.”

Describing possible disease progression without interpretation

Detailed description of disease reevaluation findings (i.e., imaging) without connection to prognosis

• Worsened imaging: “The stuff in her lungs is worse.”

• Stable/improved imaging: “Chest looks great. You still have on the one side that nodule; it is definitely not bigger, so that is good. And there are no new spots anywhere in your chest.”

• Uncertain change in imaging: “I mean there’s one little spot that he had when he came in around the second rib. That we’ve been watching, and that’s getting better every time. The rest of it in the whole area [on] the MRI shows these abnormalities that could be tumor if you just look at that in isolation.”

Expressing uncertainty without context

Direct statements of uncertainty without statements of concern about disease progression

• “The bone marrow looked a little bit different [on MRI], but it didn’t really look different on PET scan, so I don’t know what to make of that at all.”

• “[In] some places we worry that it might be getting worse - but nothing that I can say for sure.”