Factors influencing the attitudes and behaviors of oncologists regarding the truthful disclosure of information to patients with advanced and incurable cancer

Abstract

To evaluate the attitudes of the European Oncologists to information disclosure to patients with advanced cancer, their self-reported behaviors, and the factors that influence both attitudes and behaviors. ESMO members were invited to complete an online questionnaire to evaluate both attitudes and clinical behaviors relating to the disclosure of information to patients with advanced cancer. Data were analyzed to evaluate demographic, educational and social factors influencing attitudes and behaviors. Two hundred and ninety-eight completed surveys were returned. The survey demonstrated strong internal consistency construct validity. The responses indicate that individual clinicians generally display a range of behaviors including non-disclosive as well as disclosive behaviors depending on the dynamics of individual interactions between oncologist and specific patient. Although regional cultural norms influence oncologists' attitudes toward disclosure and, indirectly, their self-reported behaviors, the impact is influenced by other factors: in particular, perceived institutional professional norms, the degree of training in breaking bad news and the frequency of exposure to requests by family members to withhold information from the patient. Positive attitudes regarding disclosure of information to patients and disclosive behaviors can be encouraged, even in non-Western countries, by the development of strong professional norms and education in breaking bad news and coping with the emotional responses of patients.