Breaking bad news issues: A survey among radiation oncologists

Abstract

Introduction:Discussion of bad news and resuscitation in terminal cancer is an important but difficult and often neglected issue in day-to-day oncology practice.Materials and Methods:We interviewed 35 radiation oncologists using an indigenous 15-item questionnaire on their beliefs about breaking bad news and resuscitation to terminal cancer patients.Results:Most responders had an oncology experience of three to seven years (20/35). Thirty-two were comfortable discussing cancer diagnosis, prognosis and life expectancy-related issues. A similar number believed all cancer-related information should be disclosed, while only four believed in imparting all information in one visit. All agreed that disclosing sensitive information did not affect survival. When requested by relatives to withhold truth from patients, 11 said they would not comply, 22 agreed to tell the truth only if asked and two agreed to avoid difficult questions. Twenty responders denied having been adequately trained in breaking bad news and were keen on dedicated classes or sessions in this area of practice. Most (33/35) believed that Indian patients were keen on knowing their diagnosis and prognosis. Although all agreed to the importance of discussing resuscitation, only 17 believed patients should be involved. Majority (20/35) agreed that the issue needs to be discussed while the patient was conscious. Patients with unsalvageable disease were deemed unsuitable for aggressive resuscitation by 30 responders while the rest believed it should be offered to all. Most (21/35) admitted to feeling depressed after breaking bad news though only seven felt disclosure was more stressful than untruthful statements. Only four knew of a law regarding resuscitation in cancer.Conclusion:Observing the widely varied beliefs and practices for disclosing bad news, it is recommended that such training be a regular part of medicine curriculum, especially in the Oncology setting.

Jordanian physicians' attitudes toward disclosure of cancer information and patient participation in treatment decision-making

“…[2021] Furthermore, the proportion of physicians who indicated that the doctor should tell the patient anyway if the family has been told of a diagnosis of advanced-stage cancer and family does not want to tell the patient is higher than those reported among physicians from other Eastern countries. [232425] The most plausible explanation for the difference between Jordanian physicians and those from other Arab countries is that the change in physicians’ and the public’s attitude toward patient autonomy, self-determination, and cancer itself could be relatively fast among Jordanian physicians and the public owing to the less conservative Jordanian culture compared with several other Arab countries.…”

Truth telling in Taiwanese cancer care: patients' and families' preferences and their experiences of doctors' practices

“…9 Health care professionals revealed in focus group and individual interviews that both palliative care cancer patients and their spousal/family caregivers wanted to limit the other's information about prognosis and end-of-life issues. 10 Many studies on truth telling in cancer care have focused on doctors' issues in communicating with patients [11][12][13] and their practices and perspectives of truth telling to terminally ill patients. [13][14][15][16] However, medical personnel' perspectives on truth telling may be inconsistent with those of patients and their families.…”

“…10 Many studies on truth telling in cancer care have focused on doctors' issues in communicating with patients [11][12][13] and their practices and perspectives of truth telling to terminally ill patients. [13][14][15][16] However, medical personnel' perspectives on truth telling may be inconsistent with those of patients and their families. 17,18 Previous studies on patients' or families' truth-telling preferences were mostly crosssectional and enrolled subjects from single sites.…”

A synthesis of the literature on breaking bad news or truth telling: Potential for research in India

“…Chattopadhyay and Simon[66] provided a case example to suggest that attitudes about non-disclosure are disease-specific; Indian society perceives cancer as a “disease without hope,” for instance. Recently, Kumar and colleagues[67] reported that all the 35 radiation oncologists surveyed by them dismissed the view that the condition of patients deteriorates when they know the truth. Again, all participants preferred truth telling to patients, but only 11 of them said that they would not comply with family's request to withhold bad news from patients.…”

“…Kumar[67] who examined the attitudes among 35 radiation oncologists about truth telling has merely mentioned that 21 participants felt depressed after bad news encounters. These studies were not specifically designed to examine the psychological issues confronting health care professionals in the context of truth telling.…”