Communicating prognosis of patients with advanced cancer between health care providers: a tertiary cancer center review of written correspondence

Background: Communication of prognosis and goals of care between oncologists, community health care providers (HCPs) and patients treated for advanced cancer facilitates optimal care planning. We aimed to review the frequency, content and timing of documented prognosis in written correspondence during the last year of life of advanced cancer patients.

Methods: All patients who died during palliative care or medical oncology admission in 2015 at a large, Australian tertiary center were identified. Patients with incurable solid organ cancer and reviewed ≥1 times in oncology outpatient (OP) clinic were included. We reviewed all oncology OP consultation notes and letters, oncology discharge summaries and advanced care plans over a 12-month period before death. Both internal (OP notes) and external correspondence (OP letters; discharge summaries) were reviewed for documentation of qualitative and quantitative prognosis.

Results: One hundred and forty-seven patients were included in the analysis [median age of 70 years, interquartile range (IQR), 58-77 years; males, 60%]. Most patients had a previous inpatient admission (73%). The median OP consultations per patient was 6 (IQR, 2-9) with a median rate of 63% (IQR, 41-87%) resulting in a correspondence letter. The majority of patients had a qualitative statement of prognosis documented in OP notes (63%) and external correspondence letters (61%). However only a minority had a documented quantitative prognosis in either OP notes (14%) or external correspondence letters (7%). The median time from documentation of qualitative and quantitative prognosis to death was 3.5 (IQR, 1.6-6.9) and 2.2 (IQR, 1.1-4.4) months, respectively. While almost all patients had a completed goals-of-care (GOC) form (99%), only 15% of patients had an advanced care plan.

Conclusions: Documentation of qualitative and quantitative prognosis is infrequent despite multiple clinical encounters prior to patient death. This infers inadequate communication between oncologists and other HCPs which reduces insight into patient clinical trajectory and could result in differing care between providers.