Disclosure of Prognosis to Terminally Ill Patients: Attitudes and Practices Among French Physicians

Peretti‐Watel, Patrick; Bendiane, Marc Karim; Obadia, Yolande; Lapiana, Jean-Marc; Galinier, Anne; Pégliasco, Hervé; Favre, R.; Moatti, Jean Paul

doi:10.1089/jpm.2005.8.280

Cited by 13 publications

(7 citation statements)

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“…A questionnaire was developed based on a review of the literature (2,3,8,9) and discussions among the authors. Content validity was assessed by full agreement of the authors, and face validity was confirmed by a pilot test of 20 potential participants.…”

Section: Methodsmentioning

confidence: 99%

Burden on Oncologists When Communicating the Discontinuation of Anticancer Treatment

Otani

Morita

Esaki

et al. 2011

Japanese Journal of Clinical Oncology

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ObjectiveCommunicating the discontinuation of anticancer treatment to patients is a difficult task. The primary aim of this study was to clarify the level of oncologist-reported burden when communicating about discontinuation of an anticancer treatment. The secondary aims were (i) to identify the sources of burden contributing to their levels and (ii) to explore the useful strategies to alleviate their burden.MethodsA multicenter nationwide questionnaire survey was conducted on 620 oncologists across Japan (response rate, 67%).ResultsHigh levels of perceived burden were reported by 47% of respondents, and 17% reported that they sometimes, often or always wanted to stop oncology work because of this burden. There was a significant association between high levels of burden and: a feeling that breaking bad news would deprive the patient of hope; concern that the patient's family would blame the oncologist; concern that the patient may lose self-control; and a feeling that there was not enough time to break the bad news. Strategies perceived to be useful by oncologists included training in how to effectively communicate to patients discontinuation of anticancer treatment, a reduction in total workload to allow sufficient time to break bad news, and development of a multidisciplinary model to facilitate cooperation with other professionals and facilities.ConclusionsMany oncologists reported high levels of burden relating to communication of discontinuation of anticancer treatment. A specific communication skills training program, sufficient time for communication and development of a multidisciplinary model could help alleviate the burden on oncologists.

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Section: Methodsmentioning

confidence: 99%

Burden on Oncologists When Communicating the Discontinuation of Anticancer Treatment

Otani

Morita

Esaki

et al. 2011

Japanese Journal of Clinical Oncology

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“…Post-hoc evaluation indicated strong internal consistency construct validity for each of the major subsections, in particular the 27 attitude items and the four clinical scenarios that were the basis for the clinical behavior summary scores. Compared with previously published survey tools [40,[61][62][63][64]80] this tool provided substantially greater detail regarding attitudes and self-reported clinical behaviors.…”

Section: Discussionmentioning

confidence: 99%

“…Previous surveys of oncologists' attitudes and practices regarding disclosure have indicated that oncologists vary substantially in the disclosure practices [55,[61][62][63][64][65][66][67]; further, and the degree of disclosure with any one patient is highly influenced by individual factors [65][66][67][68]. Overall, survey data indicate that oncologists from Western countries are more disclosive than those practicing in nonWestern countries [61], and that other factors such as sex [61], age [61], training in the communication of bad news [4,[69][70][71][72], and frequent requests from family members for non-disclosure [40,55,73] may affect attitudes and actual clinical behaviors.…”

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confidence: 99%

Factors influencing the attitudes and behaviors of oncologists regarding the truthful disclosure of information to patients with advanced and incurable cancer

Cherny

2010

Psycho-Oncology

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Objective: To evaluate the attitudes of the European Oncologists to information disclosure to patients with advanced cancer, their self-reported behaviors, and the factors that influence both attitudes and behaviors.Methods: ESMO members were invited to complete an online questionnaire to evaluate both attitudes and clinical behaviors relating to the disclosure of information to patients with advanced cancer. Data were analyzed to evaluate demographic, educational and social factors influencing attitudes and behaviors.Results: Two hundred and ninety-eight completed surveys were returned. The survey demonstrated strong internal consistency construct validity. The responses indicate that individual clinicians generally display a range of behaviors including non-disclosive as well as disclosive behaviors depending on the dynamics of individual interactions between oncologist and specific patient. Although regional cultural norms influence oncologists' attitudes toward disclosure and, indirectly, their self-reported behaviors, the impact is influenced by other factors: in particular, perceived institutional professional norms, the degree of training in breaking bad news and the frequency of exposure to requests by family members to withhold information from the patient.Conclusions: Positive attitudes regarding disclosure of information to patients and disclosive behaviors can be encouraged, even in non-Western countries, by the development of strong professional norms and education in breaking bad news and coping with the emotional responses of patients.

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“…Christakis, et al found in their study on self-reported practice regarding prognostication 20 that many physicians try to avoid prognostication and 43.7% reported that they usually wait to be asked by a patient. Peretti-Watel, et al 26 reported that one physician in eight opted for systematic concealment of prognosis and two-thirds expressed a preference for disclosing the prognosis to competent terminally ill patients only at the patient's request. This is comparable to our study where 70.5% and 53.3% of physicians discuss life expectancy and incurability, respectively, at the patient's request and 11.3% and 4.6%, respectively, do not discuss life expectancy and incurability.…”

Section: Discussionmentioning

confidence: 99%

“…The few studies conducted on the latter subject focus mainly on prognostic disclosure. [19][20][21]25,26 Several studies also point out the importance of the involvement of patients' relatives in the information process. [27][28][29] Although most patients prefer their relatives to be involved, it is also important to respect patients' autonomy and to obtain their consent prior to disclosing information to their relatives.…”

Section: Introductionmentioning

confidence: 99%

Information disclosure to terminally ill patients and their relatives: self-reported practice of Belgian clinical specialists and general practitioners

et al. 2009

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Objective of this study is to examine physicians' practices regarding information disclosure to terminally ill patients and to their relatives, without informing the patient. A questionnaire had been sent to a random sample of 3014 Belgian physicians from different specialties frequently involved in end-of-life care. Responses were analysed using weighted percentages, Chi-square, Mann-Whitney U-tests and a multivariate ordinal logistic regression. Response rate was 58%. Both clinical specialists and general practitioners (GPs) discuss most topics related to terminal illness with their patients except end-of-life hastening options, spirituality, life expectancy and options to withhold/withdraw life-sustaining treatment. The topics which most physicians always discuss with relatives without informing the patient are the aim of treatment, palliative care and incurability. There is a significant difference between clinical specialists and GPs. Clinical specialists and GPs discuss most end-of-life topics with the patient but omit important issues such as end-of-life hastening options and life-expectancy.

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Disclosure of Prognosis to Terminally Ill Patients: Attitudes and Practices Among French Physicians

Abstract: Disclosure of the prognosis to terminally ill patients is still far from systematic in France. Further research is needed to better understand the motivations of French physicians' disclosure practices, which are probably culturally shaped.

Cited by 13 publications

References 35 publications

Burden on Oncologists When Communicating the Discontinuation of Anticancer Treatment

Burden on Oncologists When Communicating the Discontinuation of Anticancer Treatment

Factors influencing the attitudes and behaviors of oncologists regarding the truthful disclosure of information to patients with advanced and incurable cancer

Information disclosure to terminally ill patients and their relatives: self-reported practice of Belgian clinical specialists and general practitioners

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