When It Comes To
Telling Patients Bad News,
Most Doctors Waffle
By Maggie Fox, Health and Science Correspondent
NEW ORLEANS (Reuters) - They deal with death every day, but doctors cannot bring themselves to tell terminally ill cancer patients the worst, researchers said on Saturday.
They waffle, they fudge, and in the end they exaggerate how long a patient has to live, the survey, presented to a meeting of cancer specialists in New Orleans, suggests.
Dr. Elizabeth Lamont, of the University of Chicago, questioned 258 doctors about what they told their patients before they went into a hospice -- which is a special center set up for the care of dying patients.
The doctors were responsible for 326 terminally ill cancer patients.
Only 37 percent of the doctors said they preferred telling it to the patients straight, which Lamont described as ``frank disclosure.'' Nearly 23 percent said they would not tell their patients at all about their fates, while 40 percent said they would equivocate.
Most would exaggerate how long a patient had to live, Lamont told the meeting of the American Society of Clinical Oncology (ASCO). And that is on top of an unconscious optimism that other studies have found.
For example, one study of 300 terminally ill patients found they lived a median of 26 days, but the median forecasts by their doctors had been 79 days -- and they actually told their patients they could expect to live 90 days.
``We found that as the prognosis worsened, physicians' favoring of frank disclosure decreased,'' Lamont told the meeting. The more experienced the doctor was, the more likely he or she was to gloss over the bad news.
Men were more likely to get the easy treatment, while the older the patient was, the more likely the doctor was to give the news straight, Lamont found.
``We suggest that these phenomena may interfere with optimal end-of-life care,'' Lamont said.
Cancer specialists admit they fudge but say it is, in large part, because it is so hard to tell just how long a patient will live.
``We can't tell an individual person for sure what is going to happen,'' Dr. William Oh of the Dana-Farber Cancer Institute in Boston said in an interview.
``I tend not to give them a direct answer unless they directly ask me,'' he added. ``I use words like months or years or weeks. People want to know but they want to have hope.''
But Oh said he does not lie. ``If there is somebody who might die within weeks, I tell them that,'' he said.
And some people may indicate they do not want to know. Judging this is tricky. ``I try to gauge what they want to know from me,'' Oh said.
The issue is so delicate that at ASCO meetings experts run a workshop on how to tell patients bad news. Doctors are told how to listen sympathetically to a patient's distress without becoming emotionally involved and how to carefully phrase the information so the patient does not feel misled.


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