Beliefs and practices of patients with advanced cancer: implications for communication

Abstract

The aim of this study was to investigate the beliefs that patients with advanced cancer held about the curability of their cancer, their use of alternatives to conventional medical treatment, and their need to have control over decisions about treatment. Of 149 patients who fulfilled the criteria for participation and completed a self-administered questionnaire, 45 patients (31%) believed their cancer was incurable, 61 (42%) were uncertain and 39 (27%) believed their cancer was curable. The index of need for control over treatment decisions was low in 53 patients (35.6%) and high in only 17 patients (11.4%). Committed users of alternatives to conventional medical treatments were more likely to believe that their cancer was curable (Po0.001) and to have a higher need for control over decisions about treatment (Po0.004). The mean need for control scores were highest in patients who believed that their cancer was curable, or who were uncertain about the curability of their cancer, but who acknowledged that their oncologist had reported that the cancer was incurable. The diverse beliefs, attitudes and actions of these patients were consistent with a range of psychological adaptions to a life-threatening illness, some realistic and others illusory. Illusory responses influence what communication can achieve in daily oncology practice.

Communication Strategies and Cultural Issues in the Delivery of Bad News

“…53,64 Even when discussions are held, a truthful assessment of their prognosis is often not given. 65,66 Although physician estimates of prognosis are more accurate than patient estimates, 67,68 physicians often communicate an overly optimistic prognosis, or only provide vague statements without a specific time estimate, even in patients who express a desire to hear the truth. 65,66 Patients often do not understand common statistical terms or manipulate them to make them more positive.…”

The needs of patients with advanced, incurable cancer

“…Second, health-care providers may have provided the required information, but the patients do not recall having received this material. Patients may avoid such information to help maintain a sense of hope (Leydon, 2000;Beadle et al, 2004). Another explanation may include deficits in health-care providers' training and education, system time and related financial restrictions or competing priorities.…”

Deciding what information is necessary: do patients with advanced cancer want to know all the details?

“…10 Other studies have demonstrated high rates of confusion in advanced cancer patients as to whether their cancer is curable or incurable. 11,12 There are also high rates of discordance between patients and their families, with one Australian survey finding in over a third of those with incurable cancer only one of the patient-carer pair understood that their treatment was not intended to cure. 13 Patient-physician disparity regarding understanding of prognosis may be due to a range of factors (Table 1).…”