Resident preparedness in discussing prognosis in patients with advanced lung cancer

Teaching delivery of bad news is part of the standard medical school curriculum. Lung cancer is a common disease with poor outcomes; therefore, "poor prognosis" discussions occur frequently. Trainee preparedness to conduct these has not been studied well to date. We surveyed residents treating lung cancer in Ontario, assessing preparedness to discuss a poor prognosis.

A 17-question survey was distributed to residents in medical oncology, palliative care, radiation oncology, respirology, and thoracic surgery. The survey questioned demographics, prior communication skills training, lung cancer knowledge, comfort in discussing a poor prognosis, and preferred approach to these consultations.

Of 153 surveys distributed, 46% were completed. Most residents (68%) were Canadian trained and 70% were in the second-half of training. Lung cancer knowledge scores appear to be related to specialty (p = 0.016); medical oncology residents scored higher (mean score 2.7/4) than other specialties (range 0-1.9). Comfort in discussing prognosis increased with years of training (p < 0.0001). Observation of attending physicians was the preferred learning method (58%, p < 0.0001). Similar numbers of residents preferred an optimistic or realistic approach in a poor prognosis consultation (49% versus 45%). Lung cancer knowledge, training location, specialty, age, gender, and level of comfort or preparedness in discussing bad news did not influence the approach taken by residents in a scenario of discussing a poor prognosis.

Comfort in discussing bad news improves with time. Residents rate observation the most useful tool in learning this skill. Efforts to enhance preparedness should include resident attendance and involvement in these consultations.