Human verifications: Computable with truth values outside logic.

Cognitive scientists treat verification as a computation in which descriptions that match the relevant situation are true, but otherwise false. The claim is controversial: The logician Gödel and the physicist Penrose have argued that human verifications are not computable. In contrast, the theory of mental models treats verification as computable, but the two truth values of standard logics, true and false, as insufficient. Three online experiments (n = 208) examined participants' verifications of disjunctive assertions about a location of an individual or a journey, such as: 'You arrived at Exeter or Perth'. The results showed that their verifications depended on observation of a match with one of the locations but also on the status of other locations (Experiment 1). Likewise, when they reached one destination and the alternative one was impossible, their use of the truth value: could be true and could be false increased (Experiment 2). And, when they reached one destination and the only alternative one was possible, they used the truth value, true and it couldn't have been false, and when the alternative one was impossible, they used the truth value: true but it could have been false (Experiment 3). These truth values and those for falsity embody counterfactuals. We implemented a computer program that constructs models of disjunctions, represents possible destinations, and verifies the disjunctions using the truth values in our experiments. Whether an awareness of a verification's outcome is computable remains an open question.

Fit for Purpose Approach To Evaluate Detection of Amino Acid Substitutions in Shotgun Proteomics.

Amino acid substitutions (AASs) alter proteins from their genome-expected sequences. Accumulation of substitutions in proteins underlies numerous diseases and antibiotic mechanisms. Accurate global detection of AASs and their frequencies is crucial for understanding these mechanisms. Shotgun proteomics provides an untargeted method for measuring AASs but introduces biases when extrapolating from the genome to identify AASs. To characterize these biases, we created a "ground-truth" approach using the similarities betweenEscherichia coli and Salmonella typhimurium to model the complexity of AAS detection. Shotgun proteomics on mixed lysates generated libraries representing ∼100,000 peptide-spectra and 4161 peptide sequences with a single AAS and defined stoichiometry. Identifying S. typhimurium peptide-spectra with only the E. coli genome resulted in 64.1% correctly identified library peptides. Specific AASs exhibit variable identification efficiencies. There was no inherent bias from the stoichiometry of the substitutions. Short peptides and AASs localized near peptide termini had poor identification efficiency. We identify a new class of "scissor substitutions" that gain or lose protease cleavage sites. Scissor substitutions also had poor identification efficiency. This ground-truth AAS library reveals various sources of bias, which will guide the application of shotgun proteomics to validate AAS hypotheses.

Validation of HAND OA US inflammatory and structural damage score (HOUSE) for thumb base joints: Systematic review on truth & discrimination.

OBJECTIVES: Recently, the HAND osteoarthritis (OA) ULTRASOUND (US) Examination (HOUSE) inflammatory and structural damage scores were developed by the OMERACT US working group. However, the thumb base was not or only partly included. This systematic review examines US scoring methods and scanning techniques assessing thumb base OA, alongside existing evidence on validity, reliability, and responsiveness. METHODS: A comprehensive search strategy in three different databases identified 30 eligible studies. RESULTS: In general, studies predominantly focused on US assessment of the carpometacarpal (CMC) 1 joint, with fewer investigating the scaphotrapeziotrapezoid (STT) joint. Most studies utilized a semiquantitative scale for scoring structural and inflammatory features, aligning with the HOUSE scoring system. Validity was supported by a limited number of studies, with one demonstrating a positive association between US structural damage and radiographic damage, and another showing a similar association with function. Associations between US inflammatory features and pain were observed, albeit with some variability. Reliability was from moderate to good for the CMC1 joint but limited for STT joint. Responsiveness varied across studies. The methodological quality of included studies varied, indicating areas for future research improvement. CONCLUSION: While promising, additional research is necessary to validate the HOUSE scoring system and improve its clinical utility for thumb base OA assessment. Future research should concentrate on optimal scanning positions and on the reliability and responsiveness of the HOUSE scoring system.

Predicaments and coping strategies in implementing cancer truth-telling: a qualitative content analysis.

PURPOSE: The patient-centered communication principles in Western countries are widely esteemed. In Eastern countries, a family-centered approach to medical decision-making is preferred. However, the predicaments faced by attending physicians and their coping strategies in the process of truth-telling about cancer are unknown. Therefore, this study aimed to understand attending physicians' predicaments and coping strategies in implementing truth-telling for cancer in Taiwan. METHODS: This study used a qualitative description approach to conduct in-depth interviews with attending physicians. Data were collected from two medical centers in Taiwan. Purposive sampling was also conducted. A total of 17 attending physicians participated in individual semi-structured interviews. All interviews were audio recorded and transcribed verbatim. Inductive content analysis was used to analyze and develop the subcategories, generic categories, and main categories. RESULTS: Four main categories emerged: (1) Causing harm to the patient: Family members' cooperation is needed. (2) Family members' request to conceal the truth: Physicians should judge based on the patient's disease condition. (3) Delayed treatment: Physicians should prioritize establishing confidence. (4) Delivering bad news about relapse: Physicians have different coping strategies. CONCLUSION: Physicians in Taiwan face challenges but prioritize family-centered care despite having coping strategies to protect patients. When faced with a scenario in which family members request concealment of truth, most physicians cooperate with them to determine the level and method of disclosing unfavorable news to patients. Physicians should prioritize patients' psychological needs when they experience relapse or metastasis or face strong negative emotions.

The relevance of syntactic complexity for truth judgments: A registered report.

Fluency theories predict higher truth judgments for easily processed statements. We investigated two factors relevant for processing fluency: repetition and syntactic complexity. In three online experiments, we manipulated syntactic complexity by creating simple and complex versions of trivia statements. Experiments 1 and 2 replicated the repetition-based truth effect. However, syntactic complexity did not affect truth judgments although complex statements were processed slower than simple statements. This null effect is surprising given that both studies had high statistical power and varied in the relative salience of syntactic complexity. Experiment 3 provides a preregistered test of the discounting explanation by using improved trivia statements of equal length and by manipulating the salience of complexity in a randomized design. As predicted by fluency theories, simple statements were more likely judged as true than complex ones, while this effect was small and not moderated by the salience of complexity.

Disclosing the undisclosed: are radiographers and healthcare scientists required to communicate a provisional diagnosis when asked?

Patients need to be given the relevant information to be able to give informed consent, which might require the disclosure of a provisional diagnosis. Yet, there is no duty to give information to a patient if that patient is aware that this information exists but chooses not to request it. Diagnostic radiographers and healthcare scientists are often responsible for ensuring that patients have given informed consent for the investigations they undertake, but which were requested by other clinicians. Here we examine if they have a duty to disclose a patient's provisional diagnosis made by a referring clinician if the patient asks for this information as part of the informed consent process to a diagnostic investigation. We first consider aspects of UK law, professional guidance and salient ethical principles, emphasising that while professional codes of practice highlight the need to act in the patient's best interest, they do not require giving patients information they do not require for the examination or have not requested. We then propose that diagnostic radiographers and healthcare scientists placed in such a position use a 'minimally necessary disclosure' framework. This framework fulfils their commitment to their patient and the principle of veracity, while respecting the boundaries of their professional duties. The framework ensures that enough detail is given to the patient for them to be able to give informed consent, while shouldering the diagnostic professional from making a full disclosure, which is the duty of the referring clinician.

Elementary school-aged children's perceptions of academic dishonesty: Definitions and moral evaluations of cheating behaviors in school.

A total of 76 children (Mage = 9 years 5 months, SD = 2.22 years) participated in a structured interview about their experiences with and knowledge of academic dishonesty. Overall, 27% of the sample reported having cheated in school. Most of these children were 10 to 13 years old, and the most prevalent form of cheating behavior reported was using forbidden materials during a test. Children's age group was a significant positive predictor of their reported cheating history; however, no significant difference was found between children's gender and engagement with cheating. Children's moral evaluations of cheating did not predict their reported cheating history, nor did children's parents' cheating history. Vignette type (cheating vs. non-cheating), age group, and the interaction between vignette type and age group were significant predictors of children's ability to accurately identify behaviors that constitute cheating. Children rated cheating behaviors as significantly less moral than non-cheating behaviors. Overall, the current results provide insight into what forms of cheating behavior children engage in at the elementary school-age level.

The illusory certainty: Information repetition and impressions of truth enhance subjective confidence in validity judgments independently of the factual truth.

People not only judge repeatedly perceived information as more likely being true (the so-called truth effect) they also tend to be more confident after judging the validity of repeated information. These phenomena are assumed to be caused by a higher subjective feeling of ease (i.e., fluency) when processing repeated (vs. new) information. Based on the suggestion that a higher number of coherent mental activations is promoting a fluency experience, we argue that besides repetition an already existing information network, that is (nonspecific) prior knowledge, can enhance fluency. Following this argumentation, information repetition as well as the act of judging incoming information as being true (vs. false) should feed into subjective confidence - independently of the factual truth (when judging under uncertainty). To test this, we reanalyzed two published data sets and conducted a new study. In total, participants (N = 247) gave 29,490 truth judgments and corresponding ratings of subjective confidence while attending two judgement phases (i.e., 10 min and 1 week after the exposure phase in each experiment). Results showed that (a) repetition (in 3 of 3 data sets) and (b) impressions of truth (in 2 of 3 data sets) were systematically related to higher subjective confidence. Moreover, we found (c) a significant positive interaction between repetition and impressions of truth after both intervals in all data sets. Our analyses further underline the moderating effect of time: Influences of repetition significantly decreased with increasing time interval. Notably, the factual truth did not systematically affect any of the above reported effects.

The effect of value on context and target recollection in memory for truth and falsity.

Memory for truth and falsity has recently been investigated from the perspective of the dual-recollection theory, showing better context and target recollection for truth than falsity. In this paper, we examine whether these memory effects obtained for true statements are similar to the value effect, whereby true statements are given higher priority in encoding. For this purpose, we implemented value-directed remembering (VDR) into the conjoint-recognition paradigm. In our first experiment, the primary goal was to verify how VDR influences the processes defined by dual-recollection theory. At study, prioritized/important items were linked to higher numerical values (e.g., 10), while unimportant ones had lower values (e.g., 1). At test, the participants' task was to recognize whether a particular sentence was important, unimportant, or new. We found that both context and target recollection were better for important items. In the second experiment, the main goal was to study the combined effects of importance and veracity on memory. In the between-subjects design, participants were monetarily rewarded for memorizing true or false sentences. The results demonstrated differences in the ability to prioritize truth over falsity. Specifically, we found a substantial increase in context recollection for prioritized true information but not for prioritized false information. Moreover, we found higher context recollection for true than false sentences in the true-prioritized condition, but not in the false-prioritized condition. These results indicated that people are able to prioritize true information better than false, and suggested that memory for truth may be a special case of the value effect.

Telling the truth to patients before hip fracture surgery.

BACKGROUND: Hip fracture repair surgery carries a certain mortality risk, yet evidence suggests that orthopedic surgeons often refrain from discussing this issue with patients prior to surgery. AIM: This study aims to examine whether orthopedic surgeons raise the issue of one-year post-surgery mortality before hip fracture repair surgery and to explore factors influencing this decision. METHOD: The study employs a cross-sectional design, administering validated digital questionnaires to 150 orthopedic surgeons. RESULTS: A minority of orthopedic surgeons reported always informing patients about the risk of mortality in the year following hip fracture surgery. The main reasons for not discussing this risk were a desire to avoid frightening patients, time constraints, and concerns about undermining patient hope. Orthopedic surgeons reported a medium-high level of perceived self-efficacy, with higher self-efficacy associated with a reduced likelihood of discussing one-year mortality risk. Conversely, older age and holding a specialist status in orthopedic surgery were associated with an increased likelihood of discussing this risk with patients. CONCLUSIONS: These findings suggest a need for interventions to address communication barriers and ensure consistent provision of essential information to patients undergoing hip fracture surgery. Additionally, they highlight the importance of considering individual factors such as self-efficacy, age, and expertise in designing strategies to improve patient-provider communication in orthopedic care settings. TRIAL REGISTRATION: The study doesn`t report the results of a health care intervention.

Automatic caries detection in bitewing radiographs-Part II: experimental comparison.

OBJECTIVE: The objective of this study was to compare the detection of caries in bitewing radiographs by multiple dentists with an automatic method and to evaluate the detection performance in the absence of a reliable ground truth. MATERIALS AND METHODS: Four experts and three novices marked caries using bounding boxes in 100 bitewing radiographs. The same dataset was processed by an automatic object detection deep learning method. All annotators were compared in terms of the number of errors and intersection over union (IoU) using pairwise comparisons, with respect to the consensus standard, and with respect to the annotator of the training dataset of the automatic method. RESULTS: The number of lesions marked by experts in 100 images varied between 241 and 425. Pairwise comparisons showed that the automatic method outperformed all dentists except the original annotator in the mean number of errors, while being among the best in terms of IoU. With respect to a consensus standard, the performance of the automatic method was best in terms of the number of errors and slightly below average in terms of IoU. Compared with the original annotator, the automatic method had the highest IoU and only one expert made fewer errors. CONCLUSIONS: The automatic method consistently outperformed novices and performed as well as highly experienced dentists. CLINICAL SIGNIFICANCE: The consensus in caries detection between experts is low. An automatic method based on deep learning can improve both the accuracy and repeatability of caries detection, providing a useful second opinion even for very experienced dentists.

Nurses' experiences of reporting the medical errors of their colleagues: a qualitative study.

BACKGROUND: Medical error is a leading cause of disability and death in healthcare settings and reporting colleagues' medical errors is one of the main strategies for medical error management and an ethical responsibility of all healthcare providers, including nurses. Most studies into reporting colleagues' medical errors used quantitative designs while it seems that using qualitative designs can provide better insight in this area. PURPOSE: This study explored nurses' experiences of reporting the medical errors of their colleagues. METHODS: This qualitative study was conducted using the conventional content analysis approach. Participants were 22 hospital nurses purposively selected in 2021-2022 from different cities in Iran. Twenty-two in-depth semi-structured interviews were held for data collection. The data were analyzed via Graneheim and Lundman's conventional content analysis and trustworthiness was maintained using the criteria proposed by Guba and Lincoln. FINDINGS: The main categories of the study were burnout and intention to leave the profession and growth and development. The two subcategories of the first category were the experience of injury and the experience of violence and the two subcategories of the second category were sense of worthiness and sense of motivation. Moral distress was the most important experience of almost all participants. CONCLUSION: Nurses mostly have negative experiences in terms of reporting their colleagues' medical errors. Negative experiences can act as the barriers to report colleagues' errors while positive experiences can act as its facilitators. Improvement of the patient safety culture in healthcare settings and interpersonal relationships among healthcare providers can reduce the negative experiences and promote the positive experiences of reporting colleagues' medical errors.

How individuals perceive their partner's relationship behaviors when worrying about finances.

What role do financial worries play in close relationship functioning? In this research, we examine how financial worry - negative thoughts and feelings about finances - is associated with perceived relationship behaviors. Participants recalled how their partner acted during a recent disagreement (Study 1, N = 97 couples) or recalled the frequency of positive and negative behaviors enacted by their partner during the previous week (Study 2, N = 99 couples). Feeling more worried about finances was associated with recalling less supportive behavior from one's partner at the disagreement (Study 1) and with perceiving more negative behaviors from one's partner in the last week (Study 2). Truth and Bias Model analyses suggest that part of this link may be attributed to biased perceptions, as the link between financial worry and perceiving more negative behaviors persisted even after controlling for participants' own reported behaviors (i.e., accounting for similarity) and for their partner's own reported behaviors (i.e., accounting for accurate perceptions). In sum, financial worry is linked to how partners notice and interpret a loved one's actions within their relationship.

Truth-telling to the seriously ill child - Nurses' experiences, attitudes, and beliefs.

BACKGROUND: Nurses play an integral role in the care of children hospitalised with a serious illness. Although information about diagnostics, treatments, and prognosis are generally conveyed to parents and caregivers of seriously ill children by physicians, nurses spend a significant amount of time at the child's bedside and have an acknowledged role in helping patients and families understand the information that they have been given by a doctor. Hence, the ethical role of the nurse in truth disclosure to children is worth exploring. METHODS: A systematic academic database and grey literature search strategy was conducted using CINAHL, Medline Psych Info, and Google Scholar. Keywords used included truth, children, nurse, disclosure, serious illness, and communication. A total of 17 publications of varying types were included in the final data set. ETHICAL CONSIDERATIONS: As this was a review of the literature, there were no direct human participants. Empirical studies included in the review had received ethics approval. RESULTS: Of the 17 articles included in the review, only one directly reported on the experiences of nurses asked to withhold the truth from patients. Empirical studies were limited to HIV-positive children and children diagnosed with cancer and the dying child. CONCLUSION: A paucity of literature exploring the experiences, attitudes, and beliefs of nurses with regard to truth-telling to seriously ill children is evident. Little consideration has been given to the role nurses play in communicating medical information to children in a hospital setting. The 17 articles included in the review focused on cancer, and HIV, diagnosis, and end-of-life care. Further research should be undertaken to explore the experiences and attitudes of nurses to clinical information sharing to children hospitalised with a wide range of serious illnesses and in diverse clinical scenarios.

Examining therapist estimation of client working alliance and client symptom outcome using truth and bias model and response surface analysis.

OBJECTIVE: The aims of this study were to investigate the congruence and discrepancy between Chinese therapist trainees' estimated client working alliance (WA) and their clients' actual WA rating, and how the congruence and discrepancy predicted client symptom outcome. METHODS: Participants were 211 beginning therapist trainees and 1216 clients. Data from their 6888 sessions were analyzed using Truth and Bias Model and Response Surface Model. RESULTS AND CONCLUSIONS: (i) Chinese trainees' estimation of client WA was on average significantly lower than actual client WA. (ii) At the between-person level, whether the trainee generally over- or underestimated client WA was not related to the client's initial symptom level or symptom improvement rate. (iii) At the within-person between-session level, a session where a trainee accurately perceived high client WA, compared to a session where the trainee accurately perceived low client WA, was followed by greater client symptom relief before the next session. In the case of estimation bias, a session where the trainee underestimated client WA was followed by greater client symptom reduction in the next session, rather than the other way around when the trainee overestimated client WA. Implications on therapist training were discussed.

Processing of Counterfactual Conditional Sentences with Differential Propositional Truth-Value in Mandarin Chinese: Evidence from ERP.

Although many studies document the role of propositional truth-value in human psychological reading behavior, there is a relative paucity of research examining the role of differential propositional truth-value in processing Chinese counterfactual conditionals. This study is to investigate the role of differential propositional value in processing Chinese counterfactual conditionals by means of ERPs (event-related potentials). The study is based on comprehending two types of Chinese counterfactual conditionals, which is propositional truth value introduced by two different markers of conditional conjunctions in the protasis and apodosis, such as true counterfactual conditional markers jiaru (if) & jiu (so) in the sentence wo xiang yu jiaru you tui jiu keyi zai shuixia zhixi (I think if fish had legs so they could stifle under water), and false counterfactual conditional markers ruguo (if) & namo (then) in the sentence wo xiang gou ruguo you lin namo keyi zai shuixia huxi (I think if dogs had scales, then they could breathe under water). Two counterfactual propositional values (i.e. true and false propositional values) are constructed through manipulating sentence counterfactuality between the true and false counterfactual conditional markers in the protasis and the apodosis. Twenty-four full-time Chinese college students participated in the ERP study. The results demonstrated that processing the true counterfactual propositional sentences with conditional markers jiaru (if) & jiu (so) elicited the N400 effect relative to false propositional sentences with conditional markers ruguo (if) & namo (then). Moreover, the counterfactual sentences with true propositional conditions varied from the elicitation of the N400 effect in the protasis and absence of the N400 effect in the apodosis, showing that semantic roles may gradually disappear under the impact of truth value of propositional counterfactual condition, and/or the roles of semantic anomaly was eliminated in the accumulated sentence processing. While for the false counterfactual conditional sentences, elicitations of P300 in the protasis and robust N400 effect in the apodosis were shown, indicating the increasing semantic role in the processing. Interestingly, there was the absence of the P600 effect for processing sentences with syntactic violation, suggesting little extra syntactic cost in processing sentences with false propositional condition.

[The lie: Hiding to tell, telling to hide]. / Le mensonge : cacher pour dire, dire pour cacher.

We all lie. Some more than others, and others still have made it a way of life in relationships. There is a fine line between the normal and the pathological. It is certainly more psychologically comfortable to side with the truth than with lies. So what is it that drives the liar to stick to his guns?

Picky with peakpicking: assessing chromatographic peak quality with simple metrics in metabolomics.

BACKGROUND: Chromatographic peakpicking continues to represent a significant bottleneck in automated LC-MS workflows. Uncontrolled false discovery rates and the lack of manually-calibrated quality metrics require researchers to visually evaluate individual peaks, requiring large amounts of time and breaking replicability. This problem is exacerbated in noisy environmental datasets and for novel separation methods such as hydrophilic interaction columns in metabolomics, creating a demand for a simple, intuitive, and robust metric of peak quality. RESULTS: Here, we manually labeled four HILIC oceanographic particulate metabolite datasets to assess the performance of individual peak quality metrics. We used these datasets to construct a predictive model calibrated to the likelihood that visual inspection by an MS expert would include a given mass feature in the downstream analysis. We implemented two novel peak quality metrics, a custom signal-to-noise metric and a test of similarity to a bell curve, both calculated from the raw data in the extracted ion chromatogram, and found that these outperformed existing measurements of peak quality. A simple logistic regression model built on two metrics reduced the fraction of false positives in the analysis from 70-80% down to 1-5% and showed minimal overfitting when applied to novel datasets. We then explored the implications of this quality thresholding on the conclusions obtained by the downstream analysis and found that while only 10% of the variance in the dataset could be explained by depth in the default output from the peakpicker, approximately 40% of the variance was explained when restricted to high-quality peaks alone. CONCLUSIONS: We conclude that the poor performance of peakpicking algorithms significantly reduces the power of both univariate and multivariate statistical analyses to detect environmental differences. We demonstrate that simple models built on intuitive metrics and derived from the raw data are more robust and can outperform more complex models when applied to new data. Finally, we show that in properly curated datasets, depth is a major driver of variability in the marine microbial metabolome and identify several interesting metabolite trends for future investigation.

Seeing beyond the spikes: reconstructing the complete spatiotemporal membrane potential distribution from paired intra- and extracellular recordings.

Although electrophysiologists have been recording intracellular neural activity routinely ever since the ground-breaking work of Hodgkin and Huxley, and extracellular multichannel electrodes have also been used frequently and extensively, a practical experimental method to track changes in membrane potential along a complete single neuron is still lacking. Instead of obtaining multiple intracellular measurements on the same neuron, we propose an alternative method by combining single-channel somatic patch-clamp and multichannel extracellular potential recordings. In this work, we show that it is possible to reconstruct the complete spatiotemporal distribution of the membrane potential of a single neuron with the spatial resolution of an extracellular probe during action potential generation. Moreover, the reconstruction of the membrane potential allows us to distinguish between the two major but previously hidden components of the current source density (CSD) distribution: the resistive and the capacitive currents. This distinction provides a clue to the clear interpretation of the CSD analysis, because the resistive component corresponds to transmembrane ionic currents (all the synaptic, voltage-sensitive and passive currents), whereas capacitive currents are considered to be the main contributors of counter-currents. We validate our model-based reconstruction approach on simulations and demonstrate its application to experimental data obtained in vitro via paired extracellular and intracellular recordings from a single pyramidal cell of the rat hippocampus. In perspective, the estimation of the spatial distribution of resistive membrane currents makes it possible to distiguish between active and passive sinks and sources of the CSD map and the localization of the synaptic input currents, which make the neuron fire. KEY POINTS: A new computational method is introduced to calculate the unbiased current source density distribution on a single neuron with known morphology. The relationship between extracellular and intracellular electric potential is determined via mathematical formalism, and a new reconstruction method is applied to reveal the full spatiotemporal distribution of the membrane potential and the resistive and capacitive current components. The new reconstruction method was validated on simulations. Simultaneous and colocalized whole-cell patch-clamp and multichannel silicon probe recordings were performed from the same pyramidal neuron in the rat hippocampal CA1 region, in vitro. The method was applied in experimental measurements and returned precise and distinctive characteristics of various intracellular phenomena, such as action potential generation, signal back-propagation and the initial dendritic depolarization preceding the somatic action potential.

Prevalence and Predictors of Physician-Patient Discordance in Prognostic Perceptions in Advanced Cancer.

BACKGROUND: Discordance between physicians' and patients' prognostic perceptions in advanced cancer care threatens informed medical decision-making and end-of-life preparation, yet this phenomenon is poorly understood. We sought to: (1) describe the extent and direction of prognostic discordance, patients' prognostic information preferences in cases of prognostic discordance, and physicians' awareness of prognostic discordance; and (2) examine which patient, physician, and caregiver factors predict prognostic discordance. MATERIALS AND METHODS: Oncologists and advanced cancer patients (median survival ≤12 months; n = 515) from 7 Dutch hospitals completed structured surveys in a cross-sectional study. Prognostic discordance was operationalized by comparing physicians' and patients' perceptions of the likelihood of cure, 2-year mortality risk, and 1-year mortality risk. RESULTS: Prognostic discordance occurred in 20% (likelihood of cure), 24%, and 35% (2-year and 1-year mortality risk) of physician-patient dyads, most often involving patients with more optimistic perceptions than their physician. Among patients demonstrating prognostic discordance, the proportion who preferred not knowing prognosis varied from 7% (likelihood of cure) to 37% (1-year mortality risk), and 45% (2-year mortality risk). Agreement between physician-perceived and observed prognostic discordance or concordance was poor (kappa = 0.186). Prognostic discordance was associated with several patient factors (stronger fighting spirit, self-reported absence of prognostic discussions, an information source other than the healthcare provider), and greater physician-reported uncertainty about prognosis. CONCLUSION: Up to one-third of the patients perceive prognosis discordantly from their physician, among whom a substantial proportion prefers not knowing prognosis. Most physicians lack awareness of prognostic discordance, raising the need to explore patients' prognostic information preferences and perceptions, and to tailor prognostic communication.