Emotional responses of oncologists when disclosing prognostic information to patients with terminal disease: Results of qualitative data from a mailed survey to ASCO members

Abstract

8520 Background: Prior studies describe physician reluctance to reveal prognostic information to advanced cancer patients (acp), but little data exists describing their actual disclosure practices. Methods: A mailed survey was conducted to assess medical oncologists’ (MOs) self-reported behaviors, beliefs, and attitudes regarding prognostic conversations with terminally ill acp. Following letter pre-notification, surveys were mailed to a systematic sample of 1,222 MOs with U.S. addresses listed in the 2004 ASCO Membership Directory. Surveys contained a $25 gift card. The survey included qualitative questions eliciting emotional responses when communicating prognostic information to acp. Results: 729 surveys were completed and returned (60% response rate) with 654 providing qualitative responses (90%). The median age was 51 (range, 34–80) with male predominance (80%). Practice representation was: 56% (private), 23% (academic-based) and 20% (other active practice). MOs most commonly (47%) expressed negative emotions including sadness, pain, depression, heartache, feelings of loss, guilt, anxiety, stress, and finally discomfort with how their patient might react. They reported these conversations as unhappy, unpleasant, frustrating, and bothersome. They also described them as difficult, hard, exhausting and/or draining. 31% of MOs reported empathy, sympathy, compassion, caring, supportiveness, comfort, or being calm during prognostic disclosure. 14% reported positive feelings including optimism, hope, helpfulness, gratification, reward, or relief. 11% related emotional objectivity, detachment, control, or neutrality. Finally, MOs responses listed younger acp age as being a determinant of negative emotions. Conclusions: Negative emotions are more commonly described by MOs when asked to discuss their feelings toward prognostic disclosure. A lesser proportion described objectivity or a lack of emotion. Some related positive emotions. This qualitative data provides a greater explanation for MOs reluctance to disclose prognostic information. No significant financial relationships to disclose.