Physicians' attitudes to and problems with truth-telling to cancer patients

Abstract

Disclosure of a diagnosis of cancer to patients is a major problem among physicians in Italy. The aim of the study was to assess physicians' attitudes to and opinions about disclosure. A convenience sample of 675 physicians in Udine (North Italy) completed a ten-item questionnaire. About 45% indicated that, in principle, patients should always be informed of the diagnosis, but only 25% reported that they always disclosed the diagnosis in practice. Physicians with a surgical specialization employed in general hospitals endorsed disclosure of the diagnosis more frequently than GPs and older physicians. One third of the responding physicians persist in the belief that the patients never want to know the truth. Hospital doctors considered the hospital, rather than the patient's home, was the most appropriate place to inform the patients. The opposite result was found among GPs. Almost all the physicians endorsed the involve-

Communication training in oncology: results of intensive communication workshops for Italian oncologists

“…Significant differences were detected among geographical areas of Italy, with the lowest probability of being told in patients who died in Southern Italy (29% and 7% for diagnosis and prognosis respectively). A sample of 675 Italian physicians appeared to nearly unanimously agree that family members must be told the truth regarding cancer diagnosis and prognosis, but approximately onethird of them believed that patients never want to know the truth about the diagnosis of cancer (Grassi et al 2000). These data contrast strikingly with the preferences for truth telling and the stated informational needs studied on samples of the Italian population (Morasso et al 1999;Tamburini et al 2003).…”

“…The majority of training models have been developed and tested in the USA, UK and Northern Europe (Razavi & Delvaux 1997;Fallowfield et al 1998Fallowfield et al , 2002Fallowfield & Jenkins 1999Hoffman & Steinberg 2002;Back et al 2003Back et al , 2007Razavi et al 2003), where the paternalistic approach of protecting the patient from the stress of hearing an unpleasant truth has been replaced by patient desire and physician mandate for complete truth telling as the only way to empower patients to make informed and autonomous decisions (Novack et al 1979). Available data suggest that Southern Europe is moving in the same direction but is at a different stage in the evolution of physician attitudes and practices, with many patients not being informed about diagnosis and/or prognosis while essential medical information is channelled to families (Grassi et al 2000).…”

To tell or not to tell: attitudes of Chinese oncology nurses towards truth telling of cancer diagnosis

“…Trust is one of the important elements of nurse-patient relationships in palliative care (Mok & Chiu 2004). Many physicians, especially in Asia, generally do not inform patients about the cancer diagnosis (Tan et al 1993, Hamadeh & Adib 1998, Grassi et al 2000. Thus, many cancer patients do not know the truth about their diagnosis and prognosis (Centeno-Cortes & Nunez-Olarte 1994;Mosconi et al 1991, Pronzato et al 1994, Pimentel et al 1999, Bruera et al 2000, Seo et al 2000, Mizuno et al 2002, Nord et al 2003.…”

“…In western countries, attitudes of doctors towards truth telling changed remarkably many years ago (Novack et al 1979). Doctors in western countries would usually reveal the diagnosis to cancer patients, although more than 50% of physicians in many nonwestern countries currently do not inform patients about the cancer diagnosis (Tan et al 1993, Thomsen et al 1993, Hamadeh & Adib 1998, Feldman et al 1999, Grassi et al 2000. This phenomenon may be attributed to different cultural backgrounds.…”

Is doctors' ability to identify cancer patients' worry and wish for information related to doctors' self-efficacy with regard to communicating about difficult matters?

“…Other findings show that, for example, 11% of doctors in Greece (Mystakidou et al . 1996), 32% in Portugal (Ferraz Goncalves & Castro 2001, 45% in Italy (Grassi et al . 2000) and 81% in Norway (Loge et al .…”