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

Abstract

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]

American Thyroid Association Guidelines for Management of Patients with Anaplastic Thyroid Cancer

“…The goal of this discussion is to reach consensus over the realistic treatment options that can be offered to the patient to improve continuity of care and reduce internal disagreement over goals of care. Overly optimistic messages to patients, as well as overly pessimistic messages, can dramatically affect advanced care planning discussions with patients (120-124), patient decision making, well-being, and beneficent care (125).…”

A systematic review of the methods utilised to measure the relationship between cancer patients and oncologists: Implications for future research and practice

“…Oncologists are in a unique position to develop a therapeutic relationship with a patient from the initial cancer diagnosis to prolonged survivorship and end of life. Physician relational attitude towards individual patients impacts the effectiveness of communication, patient satisfaction, treatment decisions, perceived quality of care and clinical outcomes (Bingley et al, ; Vries et al, ; Wenger & Vespa, ). Although several studies examined physician factors addressing patient preferences in cancer care, none reported the physician’s perception of the patient–oncologist relationship or its effect on subsequent medical recommendations.…”

“…Cancer patients often develop relationships with several physicians across multiple medical subspecialties. However, the patient–oncologist relationship is instrumental in guiding important discussions across the course of cancer treatment that are vital to quality PCC, including challenging conversations, like the value of continuing treatment versus pursuing comfort‐focused, end‐of‐life care (Wenger & Vespa, ). This review highlights the dearth in studies examining relational perspective from both sides of the physician–patient dyad and how this may affect patient‐centred clinical discussions across the cancer trajectory such as diagnostic testing, treatment options, symptom management and the timing of hospice referral.…”

Ethical aspects in managing patients diagnosed with digestive cancers; a review of literature

“…Besides the life quality of the patient, the psychological distress of the family members who are involved in the patient's support should be improved. The physicians' goal is to help the patient's family face the anxiety and fears for patients with digestive cancers and also, the capacity to meet everyday problems (11). The impossibility of self-feeding in eso-gastric cancers, the presence of stomata for easier feeding, the presence of stomata for intestinal evacuation are challenging for patients.…”