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Do Patients Want Their Oncologist to be a Teacher or a Cheer


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Do Patients Want Their Oncologist to be a Teacher or a Cheerleader?

November 11th, 2012 - by Dr. Jack West

http://blog.lungevity.org/2012/11/11/ch ... -or-teach/

An article recently published New England Journal of Medicine made some news in reporting that a majority of the nearly 1200 patients with metastatic lung or colon cancer interviewed relayed significant hope that chemotherapy would cure their cancer, though this is generally not a realistic expectation when these cancers are metastatic. The research doesn’t distinguish whether they were told that their cancer isn’t conventionally considered curable or whether an accurate picture was conveyed, but it wasn’t “heard” or accepted. In fact, there were likely different factors in different patients. Among the most interesting aspects of this study was that the patients who believed that they could be cured of metastatic cancer were the patients who reported the greatest satisfaction with their oncologist’s communication with them This led the authors to note in their conclusion, “In this era of greater measurement and accountability in health care, we need to recognize that oncologists who communicate honestly with their patients, a marker of a high quality of care, may be at risk for lower patient ratings.” (Italics added)

As an oncologist who generally approaches patients with a philosophy that people should have access to accurate, truthful information truth and need to know the truth to be equipped to make an informed decision about the value of treatment when there are real anticipated risks along with likely limited benefits, I found these results to be concerning. There’s no question that communicating about prognosis and the value of treatment in cancer care is an art, but it appears that many people, and perhaps even most, don’t actually want the truth. Instead, what many patients really prefer is an eternally optimistic doctor who will deflect the challenging realities. I actually see this in practice… it’s often the docs who gladhand and evade harder, time-consuming conversations about realistic expectations who are most beloved.

Realizing that the online community may represent a more information-seeking population than those relying on what they hear from their doctor, I’d like to ask whether you feel that truth-telling precludes hope in a setting of advanced cancer. Should oncologists evade the best assessment of a realistic prognosis if it’s really what many patients want? Should we only discuss prognosis when people ask directly, and if so, can patients really make an informed decision about treatment without knowing what it can or can’t realistically do for them? Would the results be different if people were asked about satisfaction with the oncologist later on, after the cancer progresses and the disease becomes harder to manage? In other words, can optimism be a lasting strategy, or do we really pay no or pay later? What style of oncologist do you prefer?

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