Ways of providing the patient with a prognosis: a terminology of employed strategies based on qualitative data.

OBJECTIVE: To identify, denote, and structure strategies applied by physicians and patients when communicating information about prognosis.
METHODS: A descriptive qualitative study based on audiotaped physician-patient encounters between 23 haematologists and rheumatologists, and 89 patients in Oslo. Classification of identified prognostic sequences was based on consensus.
RESULTS: Physicians seldom initiated communication with patients explicitly to find out their overall preferences for prognostic information (metacommunication). Instead, they used sounding and implicit strategies such as invitations, implicatures, and non-specific information that might result in further disclosure of information if requested by the patients. In order to balance the obligation to promote hope and provide (true) information, they used strategies such as bad news/good news spirals, authentications, safeguardings, and softenings. Identified strategies applied by the patients to adjust the physician-initiated prognostic information to their needs were requests for specification, requests for optimism, and emotional warnings. PRACTICE IMPLICATIONS: The study presents an empirically derived terminology so that clinicians and educators involved in medical communication can increase their awareness of prognostic communication. Based on qualitative data obtained from communication excerpts, we suggest that individual clinicians and researchers evaluate the possible benefits of more frequent use of metacommunication and explicit prognostic information.