News Delivery Varies by Country

Cancer Docs Delivery of Bad News Varies by Location

By Charnicia E. Huggins NEW YORK

May 08, 2002 (Reuters Health)

Whether a cancer doctor voluntarily delivers information to a patient about his or her prognosis may depend on what part of the world the doctor is from, according to recent study findings.

"In Western cultures, for the most part, we believe that, ethically--and also legally--patients have a right to medical information about their condition, no matter how bad it is," Dr. Walter F. Baile, of the University of Texas M.D. Anderson Cancer Center in Houston, told Reuters Health.

"In some cultures and countries, however, a different value and legal system may exist, based upon a belief that protecting the patient from psychological distress is a medical and family responsibility," Baile explained. "This can result in important medical information being withheld from the patient at the discretion of the family or physician," he added.

These findings are based on a survey of 167 cancer doctors, primarily from North and South America, Europe and Asia.

Survey questions were designed to compare doctors' attitudes toward and practices of relaying bad news to their patients. More than 4 in 10 respondents said they "occasionally to almost always" abide by a family's request to refrain from volunteering information to a patient about his or her prognosis, Baile and his colleagues report in a recent issue of the Journal of Clinical Oncology.

A similar proportion said they used euphemisms to discuss bad news, and that they offered patients additional treatments that were unlikely to be beneficial, just so the patient could remain hopeful.

Doctors who practiced in Western countries, however, were more likely to disclose a grave prognosis without being first prompted by a patient, more likely to use correct medical terminology when discussing a patient's prognosis, and less likely to offer a treatment that is not suspected to work, study findings indicate.

They also reported engaging in more discussions with their patients about treatment failure and do not resuscitate (DNR) orders than did their peers who practiced medicine in other countries.

Overall, the doctors said they discussed new cancer diagnoses with patients about 13 times per month and disease recurrence about 8 times per month. Doctors said they had to tell patients that their treatment has failed or that no further treatment is available about 7 times a month, and roughly 6 monthly discussions are about referring cancer patients to a hospice, study findings indicate.

"Physicians can avoid the potential conflict caused by different value systems by asking the patient early on in the relationship how they would want bad news handled," Baile said. "Some patients want a lot of information and some want less--a situation that is more common as disease progresses."

The researcher concluded, "It can be helpful if the patient can inform the physician of his or her style of handling information."

SOURCE: Journal of Clinical Oncology 2002;20:2189-2196.

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