Discussing Prognosis: “How Much Do You Want to Know?” Talking to Patients Who Are Prepared for Explicit Information

Mrs D, a 57-year-old woman with metastatic pancreatic cancer, is discussing treatment options with Dr B. How much should I tell her about prognosis? he wonders. She already seems nervous. Do I hand her the death sentence? Or sugarcoat the statistics? Maybe I'll wait to see if she asks. For the first time Mrs D looks up and says, "What should I expect?" Dr B balks, not having decided what to say. "Umm, I can't really predict," he mumbles. "Every patient is different." Perhaps I am mumbling, thinks Dr B, because I'm not telling her the whole truth. Mrs D nods vaguely without meeting his gaze and picks up her purse to leave. Is she dissatisfied also?