Canadian oncologist communication about prognosis disclosure with their terminally-ill patients

Abstract

6554 Background: Prior research indicates that oncologists are reluctant to discuss prognosis (prog) with their terminally-ill cancer patients (tcp), yet physician attitudes have not been well described. Methods: We surveyed Canadian medical oncologists' (mo) self-reported behaviors, beliefs and attitudes regarding prog communication (comm) with their tcp. Following a pre-notification letter, surveys were mailed to a systematic sample of 335 mo with Canadian addresses listed in the 2005 ASCO and RCPSC Members Directory. Results: Surveys were mailed with a $5 cash incentive in April, 2006. 196 surveys were completed and returned (59% response rate). Median age of respondents (res) is 44 (29–73); 66% men; 54% at university affliated institution. Res have practiced a median 11 years (1- 43) and see a median 45 (6–300) patients/week. Answering yes or no, 99% of res say their usual practice is to tell their tcp they will eventually die of their disease. Choosing from closed-ended responses: 34% say they always discuss prog, 50% discuss prog only after asking their tcp if they want the information, and 16% discuss it only if their tcp ask for the information. 34% say they always or usually communicate a timeframe as to when death may occur and 50% sometimes, rarely, or never give a timeframe. If they do not tell a tcp their prog, 19% always, 22% usually, 28% sometimes, and 24% rarely or never tell family or friends. 92% are always or usually satisfied with their prog comm. 92% say their tcp are always or usually satisfied with the comm. 96% believe prog comm education should be part of cancer-care training. 40% say such education was either absent or inadequate during their training. Older mo(<45y) were less likely to report always/usually telling their tcp timeframe re prog (OR=0.69; p=0.02) as were those who did not receive training (OR=0.35; p<0.00). Qualitative data has also been collected about: clinical factors affecting mo prog comm, associated emotions, and examples of recent prog comm. Conclusions: Almost all Canadian mo report that they tell their tcp that they have a known life-ending prog. When they do not tell their tcp they frequently tell family or friends. Most Canadian mo say they provide a prognostic timeframe to their tcp re: time left to live. No significant financial relationships to disclose.