How do cancer physicians say they discuss prognosis with their terminally-ill patients? A survey of ASCO members

Abstract

8005 Background: Information is lacking about how physicians discuss prognosis (prog) with terminally-ill cancer patients (tcp). Methods: We surveyed medical oncologists’ (med oncs) self-reported behaviors and attitudes regarding prog communication (comm) with their tcp. Following a pre-notification letter, surveys were mailed to a systematic sample of 1,222 med oncs with U.S. addresses listed in the 2004 ASCO Members Directory. Results: Surveys were mailed with a $25 gift card in November, 2004. With completed surveys still arriving, 559 surveys have been completed and returned (46% response rate). A second mailing for non-responders is planned. Median age of respondents (res) is 52 (34–80); 84% men; 54% in group private practice; 12% practice solo; 22% practice in a medical school. Res have practiced a median 19 years (2–50) and see a median 60 (0–250) patients/week. Answering yes or no, 98% of res say their usual practice is to tell their tcp they will eventually die of their disease. Choosing from closed-ended responses: 43% say they always discuss prog, 32% discuss prog only after asking their tcp if they want the information, and 14% discuss it only if their tcp ask for the information. 43% say they always or usually communicate a timeframe as to when death may occur and 57% sometimes, rarely, or never give a timeframe. If they do not tell a tcp their prog, 21% always, 27% usually, 20% sometimes, and 19% rarely or never tell family or friends. 93% are always or usually satisfied with their prog comm. 92% say their tcp are always or usually satisfied with the comm. 97% believe prog comm education should be part of cancer-care training. 66% say such education was either absent or inadequate during their training. Qualitative data has also been collected about: clinical factors influencing med oncs’ prog comm, associated emotions, and examples of recent prog comm. Conclusions: Most med oncs say they do not communicate an estimated survival time to their tcp. However, they believe in the need to either discuss the terminal nature of their tcp’ prog or at least respect tcp’ preferences for such information. While nearly all believe prog comm education is needed, the vast majority say they are satisfied with their own comm practices. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Vitas Hospice