Communicating a negative prognosis by primary care physicians

The right to information about one’s own health condition, including adverse prognosis, derives from the provisions of the Act on Patients’ Rights and Patients’ Ombudsman and the Code of Medical Ethics. Appropriate tools, such as the SPIKES protocol, can support doctors in communicating a poor prognosis. The aim of this study was to investigate how doctors working in primary care communicate information about an adverse prognosis to their patients and their relatives. 72.2% of the 744 surveyed primary care physicians claimed that they raised the issue of death or adverse prognosis with the patient when directly asked, while 63.3% provided the information themselves. However, 15.1% of doctors did this in the absence of the patient without the patient’s consent, and 40.2% of respondents indicated that they passed on information about a poor prognosis to the family with the patient’s “implicit consent”. In the study, in a selected group of primary health care (PHC) doctors who also specialised in palliative medicine, 100% of respondents declared that they had the autonomy to discuss a poor prognosis. To support GPs in exercising the patient’s right to information about their condition, it is important to use the tools and competences for communicating a poor prognosis and to use the developed relationship with the patient and their relatives to communicate a poor prognosis openly. Continuous training, including in psychological competence, with psychological support for PHC doctors and the implementation of appropriate working protocols can help.