Identifying challenges to communicating with patients about their imminent death

Area of Science:

• Oncology
• Medical Communication
• Palliative Care

Background:

• Physician attitudes toward cancer diagnosis disclosure have shifted towards full disclosure.
• Attitudes regarding prognosis disclosure have also evolved, but to a lesser extent.
• Challenges persist in communicating information about imminent death.

Purpose of the Study:

• Identify challenges in communicating information about imminent death.
• Explore patient and physician perspectives on prognosis disclosure.
• Develop strategies to improve patient understanding of their situation.

Main Methods:

• Conducted separate interviews with patients diagnosed with leukemia, myeloma, or lung cancer, and with hematologists and lung oncologists.
• Analyzed interview data using Graneheim and Lundman's content analysis model.
• Defined eight content areas within each interview set to scrutinize prognosis communication.

Main Results:

• Identified a significant discrepancy between patients' desire for full prognostic information and physicians' reluctance to provide it until death appeared imminent.
• Physicians tended to withhold prognostic details until overt signs of approaching death were present.
• Patients expressed a strong desire to be fully informed about their prognosis.

Conclusions:

• Existing guidelines for disclosing bad news require modification.
• Guidelines should promote the disclosure and discussion of uncertain prognostic information.
• Disclosure should be encouraged unless a patient explicitly opposes receiving such information or is unsuitable for dialogue.