What are terminally ill cancer patients told about their expected deaths? A study of cancer physicians' self-reports of prognosis disclosure

Abstract

Purpose: Little is known about how physicians discuss prognosis with terminally ill cancer patients. Thus, we sought to obtain cancer physicians' self-reports of their prognosis communication practices.

Methods: A survey seeking self-reports regarding prognosis communication with their terminally ill cancer patients was mailed to a systematic sample of medical oncologists in the United States.

Results: Of 1,137 physicians, 729 completed and returned surveys (64% response rate). Median age of respondents was 51 years (range, 33 to 80 years); 82% were men. Respondents had practiced cancer care for a median of 18 years (range, 1.5 to 50 years) and reported seeing a median of 60 patients per week (range, 0 to 250 patients per week). Although 98% said their usual practice is to tell terminally ill patients that they will die, 48% specifically described communicating terminal prognoses to patients only when specific preferences for prognosis information were expressed. Forty-three percent said they always or usually communicate a medical estimate of time as to when death is likely to occur, and 57% reported sometimes, rarely, or never giving a time frame. Seventy-three percent said prognosis communication education was either absent or inadequate during their training, and 96% believed it should be part of cancer care training.

Conclusion: Medical oncologists report routinely informing their terminally ill patients that they will die. However, they are divided in describing themselves as either always discussing a terminal prognosis or doing so if it is consistent with their patients' preferences for prognostic information. Most medical oncologists say they do not routinely communicate an estimated survival time to their patients.

Fig 1.

(A) Responses to the following survey question: “In telling, how often do you give your patient a specific timeframe, or medical estimate of the amount of time as to when death is likely to occur?” (n = 694). (B) Responses to the following survey question: “If or when you do not tell a patient, do you tell a spouse, relative or a close friend?” (n = 694). (C) Responses to to the following survey question: “If you were a patient with advanced cancer, would you want to be told your prognosis –including a medical estimate of time until death?” (n = 714). (D) Comparative responses to two survey questions: “How often are you/your patients satisfied with your communication practices regarding prognosis?”