Communication about cancer near the end of life

Back, Anthony L.; Anderson, Wendy G.; Bunch, Lynn; Marr, Lisa; Wallace, James A.; Yang, Holly; Arnold, Robert M.

doi:10.1002/cncr.23653

Cited by 170 publications

(123 citation statements)

References 125 publications

(145 reference statements)

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“…Acknowledging emotion is a central component of showing empathy and facilitating discussion about patients' concerns, which may ameliorate distress even if the problems themselves cannot be solved. 82 Oncology patients do not often express negative emotions to their oncologists 83 but report an increased need to talk about their worries and fears. 66 Audio-recordings of consultations in America have found empathic opportunities are present in 37% of conversations, but oncologists give empathic responses less than one-third of the time; a low rate which likely discourages any further expression of emotion by patients.…”

Section: Style Of Delivery: Verbal and Nonverbal Aspectsmentioning

confidence: 99%

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

Ward¹,

Russell²

2011

CMAR

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Abstract:Communicating effectively with patients who have advanced cancer is one of the greatest challenges facing physicians today. Whilst guiding the patient through complex diagnostic and staging techniques, treatment regimens and trials, the physician must translate often imprecise or conflicting data into meaningful personalized information that empowers the patient to make decisions about their life and body. This requires understanding, compassion, patience, and skill. This narrative literature review explores current communication practices, information preferences of oncology patients and their families, and communication strategies that may assist in these delicate interactions. Overwhelmingly, the literature suggests that whilst the majority of patients with advanced cancer do want to know their diagnosis and receive detailed prognostic information, this varies not only between individuals but also for a given individual over time. Barriers to the delivery and understanding of information exist on both sides of the physician-patient relationship, and family dynamics are also influential. Despite identifiable trends, the information preferences of a particular patient cannot be reliably predicted by demographic, cultural, or cancer-specific factors. Therefore, our primary recommendation is that the physician regularly asks the patient what information they would like to know, who else should be given the information and be involved in decision making, and how that information should be presented.

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Section: Style Of Delivery: Verbal and Nonverbal Aspectsmentioning

confidence: 99%

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

Ward¹,

Russell²

2011

CMAR

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“…Tanıyı bilmek isteyenlerden %93'ünün tanıyı koyan ve tedaviyi sürdürecek olan hekimin, %4.4'ünün aileden birisinin, %3.3'ünün ailesi ve doktorun tanıyı birlikte söylemesi gerektiğini ifade ettikleri bildirilmektedir (28). Hastaların hastalıkları ve bu hastalıktan nasıl etkileneceklerine dair bilgiye ihtiyaç duydukları; bu bilgiyi geleceklerini planlamak, tıbbi ve yaşam kararlarını almak için kullandıkları; hastaların doktorlarının dürüst olmasını ve bilgi verirken onların ne duymaya hazır olduğunu ve nasıl etkileneceklerine duyarlı olmalarını istedikleri; duymaya hazır olduklarından daha fazla bilgi istemedikleri; doktorlarının ölüm gibi hassas konuların tartışmaya açık olmasını istedikleri; ancak hazır olmadan konuşmak zorunda kalmak istemedikleri bildirilmektedir (29). Onkologların, kariyerleri boyunca ortalama 20 bin kez kötü haber verdiği ve pek çok klinisyenin bu konuda gerekli beceri eksikliği veya zorluk yaşadığı ileri sürülmektedir (30).…”

Section: Tartişma Ve Sonuçunclassified

Hekim tutumları üzerine bir çalışma: Ölüm ve ölümcül hastaya yaklaşım / A study on the attitudes of physicians: approach towards death and terminally ill

Özkıriş¹,

Güleç²,

Yenilmez³

et al. 2011

Dusunen Adam

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Araştırmalar / ResearchesÖZET Hekim tutumları üzerine bir çalışma: Ölüm ve ölümcül hastaya yaklaşım Amaç: Bu çalışmada, hekimlerin ölüm ve ölümcül hastaya ilişkin tutumları, hekimlerin sosyodemografik özellikle-rinin ölüm ve ölümcül hastaya yaklaşımları üzerine etkisi, ölümcül hastalık tanısını söylemekten kaçınma davranı-şının hekimin kendi ölüm kaygısı ile ilişkisi ve hekimlerin bu konuyla ilgili eğitimin gerekliliği hakkındaki görüşlerinin araştırılması amaçlanmıştır. Yöntem: Çalışmaya 304 hekim alınmış ve kendilerine sosyodemografik veri formu, ölüm ve ölümcül hastaya yönelik hekim tutumlarını değerlendirmek amacıyla yazarlar tarafından geliştirilen 15 soruluk bir anket formu ve Ölüm Kaygısı Ölçeği uygulanmıştır. Bulgular: Hekimlerin %89.1'i hastaların, tanıları her ne olursa olsun bilgilenme hakları olduğuna inanmakla birlikte, söz konusu hastalık "ölümcül" olduğunda, %78.3'ü tanının hastaya söylenmesi gerektiğini kabul etmektedir. Ölüm-cül hastalık 'kanser' olduğunda ise, hekimlerin tanının açıkça söylenmesi fikrine katılma oranları; kendisi söz konusu olduğunda %77.6 oranındayken, bir yakını söz konusu olduğunda %55.6, herhangi erişkin bir hasta söz konusu olduğunda ise %51 olmaktadır. "Tıp eğitimi sırasında veya sonrasında, ölüm ve ölümcül hastaya yaklaşım hakkında bir eğitim gereklidir." ifadesine hekimlerin %94.4'ü (n=287) katılmıştır. Anket sorularına verilen cevaplarda cinsiyet, çocuk sahibi olma, çalışma alanı, ölüm kaygısı düzeyine bağlı olarak farklılıklar olduğu saptanmıştır. Sonuç: Bu araştırma, hekimlik mesleği uygulamaları içinde önemi ihmal edildiği düşünülen bir alan olan, ölümcül hasta ve ölüme yaklaşımda yaşanan zorlukları bir ölçüde saptayıp tartışılır hale getirecek veriler ortaya koymuştur. Anahtar kelimeler: Ölüm, kaygı, hekim, kanser ABSTRACT A study on the attitudes of physicians: approach towards death and terminally illObjective: The aim of this study was to investigate primarily, the attitudes of physicians toward death and terminally ill patients and, secondly, the relationship between the sociodemographic variables of the physicians and these attitudes. Also, this study aimed to find out the relationship between the death anxiety of the physicians and their avoidance behavior of informing patients about their diagnoses. Lastly, the physicians were asked about the necessity of education on how to approach patients with terminal ilness. Methods: The study subjects were 304 physicians. A questionnaire about sociodemographic information, the Death Anxiety Scale and a 15 item questionnaire prepared by the authors to evaluate the attitudes of physicians were applied to the participants. Results: 89.1% of the physicians believed that patients had the right to be informed of their diagnoses, independent of what the diagnoses were. However, when the diagnosis was a terminal illness, only 78.3% of the physicians accepted that the diagnosis should be announced. In addition, when the terminal disease was cancer, 77.6% of the physicians agreed that the patient should be informed about the di...

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“…Although oncologists commonly deal with patients near death, breaking bad news can be hard even for them [11]. Yet, best practices exist for communicating with patients who have advanced and incurable cancers, including addressing the emotional impact of a life-limiting illness, consideration of clinical trials, challenges of sustaining hope, aspiring toward realistic goals, and advance care planning [12]. Even near the end of life, oncologists can facilitate patient consideration of their personal goals and preferences in the context of cancer therapy decisions [13].…”

Section: Understand Patient Preferences and Goals In Order To Inform mentioning

confidence: 99%

Ethical Issues in Patient–Physician Communication About Therapy for Cancer: Professional Responsibilities of the Oncologist

Wenger¹,

Vespa

2010

The Oncologist

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Value in cancer care from a patient-centered perspective not only requires full oncologist-to-patient communication of information about potential treatments, but also imbues in the oncologist a responsibility to evaluate the value of cancer therapies and to offer to patients only those potential therapies that are appropriate for the patient. A case is presented in which the possibility of a low-probability treatment presented without adequate context or advice led to a prolonged, unsatisfying death for a young person with advanced cancer. The professional responsibility of the oncologist includes provision of care based on wise, cost-effective management aimed at meeting the needs of the individual patient. The oncologist has the clinical knowledge, is aware of a patient's clinical details, and has the relationship with the patient that permits understanding his or her values in order to guide cancer care decisions. The oncologist must identify the spectrum of treatments that are indicated for the patient, understand patient preferences and goals in order to inform the patient about options, and advise the patient concerning choice of cancer care. Oncologists as a professional group can ensure the use of standardized outcome measures, promote communication of prognosis and goals in order to guide optimal cancer care choices, and ensure appropriate patient selection and reasonableness in the cost per benefit increment of treatments. In this way, oncologists can ensure value in cancer care. The Oncologist 2010;15(suppl 1): [43][44][45][46][47][48]

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Communication about cancer near the end of life

Cited by 170 publications

References 125 publications

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

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

Hekim tutumları üzerine bir çalışma: Ölüm ve ölümcül hastaya yaklaşım / A study on the attitudes of physicians: approach towards death and terminally ill

Ethical Issues in Patient–Physician Communication About Therapy for Cancer: Professional Responsibilities of the Oncologist

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