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Hope and persuasion by physicians during informed consent.

Victoria A Miller1, Melissa Cousino1, Angela C Leek1

  • 1Victoria A. Miller, The Children's Hospital of Philadelphia, Philadelphia, PA; Melissa Cousino, Boston Children's Hospital, Boston, MA, and Case Western Reserve University; Angela C. Leek and Eric D. Kodish, Cleveland Clinic, Cleveland, OH.

Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
|September 10, 2014
PubMed
Summary

Physicians often conveyed hope in phase I cancer trials but rarely discussed incurable disease or palliative care options. This communication style may influence parental decisions regarding cancer treatment enrollment.

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Area of Science:

  • Oncology
  • Clinical Trials
  • Medical Ethics

Background:

  • Phase I trials offer limited medical benefit for cancer patients.
  • Physician communication during informed consent is crucial for patient decision-making.
  • Hopeful and persuasive language can influence enrollment in clinical trials.

Purpose of the Study:

  • To analyze hopeful and persuasive messages used by physicians during informed consent for phase I cancer trials.
  • To assess the association between physician communication and parent/physician perceptions of trial benefits, recommendation strength, control, and pressure.
  • To evaluate how physicians discuss incurable disease and alternative care options.

Main Methods:

  • 85 children with cancer, their parents, and physicians participated.
  • Informed consent conferences (ICCs) were audiotaped and coded for physician communication.
  • Parents (n=60) and physicians completed post-conference interviews/questionnaires.

Main Results:

  • Hopeful statements often focused on positive outcomes and available options.
  • Physicians failed to mention palliative care or incurable status in 68% and 85% of ICCs, respectively.
  • Mentioning palliative care/incurable status was associated with lower physician recommendation strength.

Conclusions:

  • Physicians infrequently discussed goals beyond cure and communicated incurable disease status or palliative care options.
  • This communication pattern is concerning given the low benefit likelihood in phase I trials.
  • Physicians should help families set realistic goals when curative options are exhausted.