Oncologists Not Providing Enough Information About Palliative Care

Editor's Choice
Main Category: Cancer / Oncology
Also Included In: Palliative Care / Hospice Care
Article Date: 02 Aug 2008 - 0:00 PDT

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According to a study published on bmj.com, most cancer patients make a decision about treatment with little or no information about the survival benefits of palliative chemotherapy.

Palliative chemotherapy is a way to reduce the severity of symptoms for patients with advanced cancer. Though it is not designed to cure the cancer, the therapy has modest survival gains, of months rather than years, for patients in advanced stages of cancer. In the UK, it is expected that doctors provide accurate information to patients so an informed decision can be made before initiating chemotherapy.

Researchers from the University of Bristol, however, have found that over 66% of cancer patients remained uninformed and did not receive information about the survival benefits of palliative chemotherapy. They assessed the cases of 37 patients - with colorectal, non-small cell lung, or pancreatic cancer - at a large teaching hospital or a district general hospital in the south west of England. All of the patients had advanced cancer, and permitted digital recording of their consultations with oncologists. In order to analyze how survival gain was discussed when patients were offered palliative chemotherapy, the researchers utilized data from ASPECTS - a study of patients' of experiences treatments. Before the patient met with the oncologist, a researcher interviewed the patient. The researcher then recorded the consultation with the health professional and followed-up one more time with the patient within the following weeks.

The investigators found that physicians were consistent in informing patients that they were past the point of a cure and one was not being sought for them. However, there was considerable variance in how much information about survival benefits from palliative chemotherapy was given. Some patients received numerical data ("about four weeks") while other received an idea of timescale ("a few months extra"), vague references ("buy you some time"), or nothing at all. Of the 37 patients, six were provided with numerical data about the treatment's survival gains. Most of the consultations, 26 of 37, resulted in a vague discussion of survival benefits or in no discussion at all.

It is possible, according to the researchers, that the "intrusiveness of unfavorable numbers," such as the number of months or weeks left to live, undermines a doctor's relationship with her patient and engenders a negative state. "Giving comprehensible and appropriate information about survival benefit is extremely difficult. In addition, the reluctance to inform patients of the limited survival gain of palliative chemotherapy may be motivated by a desire to 'protect' patients from bad news," write the authors. "However, the reluctance to address these difficulties and sensitivities may be hampering patients' ability to make informed decisions about their future treatment."

The researchers suggest that oncologists and cancer teams should sensitively communicate enough information that can help a patient make an informed, realistic decision. In addition, they recommend training for oncologists to help them better communicate survival information to patients.

What oncologists tell patients about survival benefits of palliative chemotherapy and implications for informed consent: qualitative study
Suzanne Audrey, Julian Abel, Jane M Blazeby, Stephen Falk, Rona Campbell
BMJ (2008). 337: a752.
doi:10.1136/bmj.a752
Click Here to View Journal Web Site

Written by: Peter M Crosta
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