Subspecialty differences in responding to patient death--comparing cardiologists with oncologists

Cardiac deaths are more likely to be unanticipated than cancer deaths by patients, their families, and their physicians. We hypothesized that differing physician attitudes toward dying patients may affect the degree of expectation of death. To evaluate differences in attitudes and behaviors among subspecialists, we surveyed a randomly selected population of California subspecialists; 44 of 136 (32%) of cardiologists and 91 of 167 (55%) of oncologists responded. Oncologists experienced three times as many deaths as cardiologists and reported having discussed code status more often with patients who died. Cardiologists' patients' deaths were more often unexpected and occurred more frequently in intensive care units. In addition, their patients were more likely to be given cardiopulmonary resuscitation. Oncologists reported being more comfortable dealing with dying patients and having less desire to avoid them. When presented with patient scenarios, however, cardiologists' and oncologists' responses were similar when discussing and estimating prognosis and likelihood of successful therapy.