About me
Improving Patient and Caregiver Understanding of Risks and Benefits of Immunotherapy for Lung Cancer or Melanoma (UPLIFT)
Location: 57
Mentor: Dr. Lara Traeger
Prognostic communication is a cornerstone of high-quality oncology care, particularly for patients with advanced-stage disease. However, these discussions are often difficult to navigate due to clinical uncertainty, emotional sensitivity, and varying levels of patient and caregiver readiness. Patients and caregivers may avoid direct inquiries about prognosis out of fear or deference to clinician authority, while clinicians often respond ambiguously or shift focus away from prognosis. These communication breakdown dynamics can hinder decision-making and cause misalignment between patient goals and care plans. This study aims to characterize the structure of prognostic discussions and identify features linked to more effective communication. This study is a qualitative analysis of 50 audio-recorded immunotherapy consent visits with patients diagnosed with advanced-stage lung cancer or melanoma. Before each visit, patients viewed a brief educational video and received a structured question prompt list to encourage discussion about treatment goals, expectations, and outcomes. A 10-minute segment surrounding each prognostic question (5 minutes before and after) was transcribed. Using an iterative thematic coding framework, we analyzed the nature of patient and caregiver questions, clinician responses, and conversational flow. All visits included at least one prognostic question. Most questions were phrased indirectly and emerged during logistical discussions, including treatment timelines and scan schedules. Caregivers more frequently initiated these questions and often approached them cautiously. Clinician responses typically involved general reassurance or redirection to treatment plans, with limited discussion of explicit prognostic information. Findings underscore the need for interventions such as clinician communication training and patient-centered tools to promote more transparent, empathetic prognostic dialogue.
