  
Many patients are too optimistic about stem-cell transplantation outcome
Last Updated: 2001-02-27 16:00:56 EST (Reuters Health)
WESTPORT, CT (Reuters Health) - Stem-cell transplantation can cure or extend the life of many patients with hematologic disorders, but at substantial risk of treatment-related morbidity and mortality. Discrepancy between patient and physician estimates of the success of this procedure is not uncommon, survey results show.
Dr. Stephanie J. Lee, from the Dana-Farber Cancer Institute, in Boston, and colleagues compared the expectations of stem-cell transplantation with the actual outcomes of 313 patients and their physicians. The results appear in The Journal of the American Medical Association for February 28.
The researchers discovered that estimates of the success of stem-cell transplantation were most concordant when the outcome was likely to be favorable. That is, patients with a low risk of procedure-related death were the most likely to correctly estimate that they had a low risk of dying. However, in cases of more advanced disease, in which the outcome was more likely to be poor, the survey results show that physicians tended to adjust their expectations, but patients did not.
The findings indicate that some patients at highest risk of treatment-related mortality do not really understand those risks, Dr. Lee told Reuters Health. Physicians therefore should be cautioned "to ask their patients what they are really expecting from procedures, especially if they are at high risk."
While patients may have "powerful psychological incentives" to remain optimistic, Dr. Lee's group writes, there is evidence to suggest that "concordance of expectations with actual outcome promotes better psychological adjustment."
"It is obviously a very complicated issue," Dr. Lee continued. "We were expecting some discrepancies, but we were surprised by the magnitude of discrepancies in the high-risk population." They conclude that there are opportunities for improved physician-patient communication in this arena.
JAMA 2001;285:1034-1038.
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