Prognosis disclosure to terminally ill cancer patients: A qualitative study among Japanese physicians.

Abstract

e20717 Background: Prognosis disclosure could facilitate end-of-life discussions and advance care planning in advanced cancer patients. However, many Japanese and Japanese American patients do not wish to know of their own prognosis, and physicians infrequently disclose terminal prognosis in Japan. We aimed to investigate Japanese physicians’ practice and emotion regarding prognosis disclosure. Methods: We adopted a qualitative design based on semi-structured interviews and content analysis. Attending physicians in a local cancer center were eligible if they had disclosed terminal prognosis to their cancer patients and/or families more than three times in the past year. The sample size was justified by recruiting participants through consistent comparison analysis until data saturation occurred. Results: We conducted 11 face-to-face interviews and detected the following categories; [practice in disclosure], [reasons for/against disclosure], and [emotion regarding disclosure]. [Practice] indicated that some physicians have almost always disclosed prognosis to their patients, while others have almost never done so. It included various skills such as “having families/nurses attend the meeting,” “asking families how much prognostic information physicians should provide to patients,” “asking patients why they want to know,” and “answering with a range of estimation.” [Reasons for disclosure] included “to help patients deal with unfinished business” and “to support realistic hope.” [Reasons against disclosure] included “uncertain prognosis,” “physicians’ concern about hurting patients,” “lack of time and staff support for physicians,” and “insufficient training in communication skills.” Lastly, many physicians felt “sad,” “nervous,” and “difficult,” while few felt “fulfilled” when disclosing prognosis. Conclusions: Practice patterns, reasons and emotional experiences vary widely in prognosis disclosure among Japanese physicians. Team approach, physician training in communication skills, and understanding of families’ as well as patients’ preferences may contribute to better-quality individualized cancer care based on patients’ goals, not on physicians’ personal preferences.