Attitudes and beliefs of palliative care physicians regarding communication with terminally ill cancer patients

Abstract

The subject of communication between palliative care physicians and their patients regarding their diagnosis and prognosis has not been extensively researched. The purpose of this survey was to compare the attitudes and beliefs of palliative care specialists regarding communication with the terminally ill in Europe, South America, and Canada. A sample of palliative care physicians from South America (Argentina and Brazil), French-speaking Europe, and Canada were identified, and posted a questionnaire. Physicians who stated that they practised palliative care at least 30% of their time were considered evaluable as palliative care specialists. Of a total of 272 questionnaires, 228 were returned (84%); and 182/228 (81%) respondents were considered to be palliative care specialists. Palliative care physicians in all three regions believed that cancer patients should be informed of their diagnosis and the terminal nature of their illness. Physicians reported that at least 60% of their patients knew their diagnosis and the terminal stage of their illness in 52% and 24% of cases in South America, and 69% and 38% of cases in Europe, respectively. All physicians agreed that 'do not resuscitate' orders should be present, and should be discussed with the patient in all cases. While 93% of Canadian physicians stated that at least 60% of their patients wanted to know about the terminal stage of their illness, only 18% of South American, and 26% of European physicians said this (P < 0.001). Similar results were found when the physicians were asked the percentage of families who want patients to know the terminal stage of their illness. However, almost all of the physicians agreed that if they had terminal cancer they would like to know. There was a significant association between patient based decision-making and female sex (P = 0.007), older age (P = 0.04), and physicians from Canada and South America (P < 0.001). Finally, in their daily decision making, South American physicians were significantly more likely to support beneficence and justice as compared with autonomy. Canadian physicians were more likely to support autonomy as compared with beneficence. In summary, our findings suggest that there are major regional differences in the attitudes and beliefs of physicians regarding communication at the end of life. More research is badly needed on the attitudes and beliefs of patients, families, and health care professionals in different regions of the world.

Lay attitudes toward deception in medicine: Theoretical considerations and empirical evidence

“…Indeed, studies have suggested that at least some physicians believe that it may be acceptable to deceive a patient if that is in the patient's best interests, either by lying to the patient or by omitting material information in disclosures to the patient, in the context of palliative care (Bruera et al 2000); when resolving difficult ethical problems (Novack et al 1989); and in some cases of placebo prescription (Howick et al 2013). Moreover, it is likely that many physicians are putting these beliefs into practice.…”

Deciding what information is necessary: do patients with advanced cancer want to know all the details?

“…A study of palliative medicine physicians showed those from South America and Europe were far less likely than their Canadian counterparts to believe that the majority of their patients wanted to know about the terminal stage of their illness; 18% and 26% versus 93%, respectively. 3 Oncologists practicing in non-Western countries may be more likely to wait for the patient to ask before disclosing a poor prognosis. 27 …”

When the Family Requests Withholding the Diagnosis: Who Owns the Truth?

“…Adding to the complexity that many cultural norms coexist in the United States for family decision making is the challenge that these norms are not uniformly embraced by all family members. 13,14 Recent immigrants and older family members may adhere to the practices of their home countries, whereas younger members may have assimilated different notions about who should make treatment decisions.…”