Physician Management of Dying Patients: An Exploration

Abstract

Although there are increasing numbers of disciplined observations and studies about the dying patient, the question remains as to whether they have been read and put into practice. This paper reports on a current study aimed at exploring how physicians actually work with patients suffering from fatal illnesses. Responding to a questionnaire on their methods of managing dying patients were 59 internists, 76 surgeons, 25 gynecologists, 13 general practitioners and 5 psychiatrists. Sixty-six percent of the physicians said they sometimes inform patients of a malignancy, 25 percent said they always tell the patient, and only 9 percent said they never tell the patient. The fact that very few physicians apparently feel justified in saying they never inform a patient about a fatal diagnosis is in itself a modification of previous practice. However, judging from answers to other questions, it is the author's impression that in actual practice many physicians tend to resist informing their patients of the diagnosis in a direct manner and are inclined to be quite selective in informing only those patients described as self-reliant, independent and able to face reality.

SPIKES—A Six-Step Protocol for Delivering Bad News: Application to the Patient with Cancer

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“…Results of survey of participants at Breaking Bad News Symposium, American Society of Clinical Oncology, 19981,2 In an average month, how often do you have to break bad news to a patient (e.g., diagnosis, recurrence, progressive disease, etc. )?…”

Breaking bad news to patients with cancer: A randomized control trial of a brief communication skills training module incorporating the stories and preferences of actual patients

“…Historically patients with cancer were routinely left uninformed regarding their diagnosis [1,2]. This was done largely with the belief that informing patients was harmful and caused undue stress.…”

Does awareness of terminal status influence survival and quality of life in terminally ill cancer patients?

“…Surveys conducted before 1970 revealed that most physicians did not inform the majority of their patients of a cancer diagnosis because they considered it inhumane and damaging to the patient to disclose the bad news about the diagnosis . As treatment advances have changed the course of cancer and as culture has embraced patient autonomy and self‐determination, physicians now inform their patients of a cancer diagnosis almost all of the time .…”