JAMA Netw Open
Clinicians can use uncertainty in serious illness talks
Clinical takeaway: Clinicians can use prognostic uncertainty constructively by naming what is unknown, watching for patient and caregiver readiness, and pacing information so planning can happen without extinguishing hope.
Prognostic conversations can be especially difficult in hematologic cancers, where disease trajectories are often unpredictable and novel therapies may leave room for remission or durable response. This study examined how trained hematology clinicians helped patients and caregivers discuss the future when treatment options were limited.
Patients and caregivers often shifted between wanting prognostic information and pulling back from it, sometimes within the same conversation. Clinicians who noticed those cues adjusted the timing, depth, and pace of information rather than pushing through a fixed script.
The central finding was that uncertainty could be useful. Clinicians used uncertainty to acknowledge limits, discuss possible decline, and still preserve room for hope. That helped patients prepare for the end of life while continuing to focus on meaningful goals and daily living.
Researchers analyzed 25 audio-recorded serious illness conversations from five Danish hematology departments, selected from 75 eligible recordings in the intervention arm of a nationwide cluster randomized trial. The conversations included 25 patient-caregiver dyads and 16 physician-nurse teams trained in the Danish Serious Illness Care Program. Patients had multiple myeloma, lymphoma, myelodysplastic syndrome, or acute leukemia; 72% were enrolled during treatment for relapsed disease.
“Prognostic uncertainty served as a constructive element and resource rather than a barrier, supporting patients’ preparation for the end of life while continuing to live meaningfully,” the study concluded.
Source: Borregaard Myrhøj C. JAMA Netw Open. 2026 Apr 29. Navigating Prognostic Dialogue During Serious Illness Conversations