Oncologists Not Providing Enough Information About Palliative Care

Main Category:Cancer  Date:2008-8-18 17:52:00  view:35
According to a study published on bmj.com, mostcancer patients make a decision about treatment with little or noinformation about the survival benefits of palliative chemotherapy.

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

Researchers from the University of Bristol, however, have found thatover 66% of cancer patients remained uninformed and did not receiveinformation about the survival benefits of palliative chemotherapy.They assessed the cases of 37 patients - with colorectal, non-smallcell lung, or pancreatic cancer - at a large teaching hospital or adistrict general hospital in the south west of England. All of thepatients had advanced cancer, and permitted digital recording of theirconsultations with oncologists. In order to analyze how survival gainwas discussed when patients were offered palliative chemotherapy, theresearchers utilized data from ASPECTS - a study of patients' ofexperiences treatments. Before the patient met with the oncologist, aresearcher interviewed the patient. The researcher then recorded theconsultation with the health professional and followed-up one more timewith the patient within the following weeks.

The investigators found that physicians were consistent in informingpatients that they were past the point of a cure and one was not beingsought for them. However, there was considerable variance in how muchinformation about survival benefits from palliative chemotherapy wasgiven. Somepatients received numerical data (about four weeks) while otherreceived an idea of timescale (a few months extra), vague references(buy you some time), or nothing at all. Of the 37 patients, six wereprovided with numerical data about the treatment's survival gains. Mostof the consultations, 26 of 37, resulted in a vague discussion ofsurvival benefits or in no discussion at all.

It is possible, according to the researchers, that the intrusivenessof unfavorable numbers, such as the number of months or weeks left tolive, undermines a doctor's relationship with her patient andengenders a negative state. Giving comprehensible and appropriateinformation about survival benefit is extremely difficult. In addition,the reluctance to inform patients of the limited survival gain ofpalliative chemotherapy may be motivated by a desire to 'protect'patients from bad news, write the authors. However, the reluctance toaddress 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 shouldsensitively communicate enough information that can help a patient makean informed, realistic decision. In addition, they recommend trainingfor oncologists to help them better communicate survival information topatients.

What oncologists tell patients about survival benefits ofpalliative 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
ClickHere to View Journal Web Site

Written by: Peter M Crosta
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