When receiving information about treatment options and prognosis, advanced cancer patients favor doctors who provide more optimistic information and perceive them to be more compassionate when delivering it. This is according to a new study published in JAMA Oncology.
The study was conducted by researchers from the University of Texas MD Anderson Cancer Center in Houston and colleagues from France, Italy and Chile.
For patients with advanced disease who are nearing the end of life, being well informed about prognosis and treatment options is key for future planning.
However, when it comes to patients with advanced cancer, many have not discussed such issues prior to reaching the end-of-life phase. For example, the research team point to a 2012 study that found 69% of lung cancer patients and 81% of colorectal cancer patients were not aware that chemotherapy was unlikely to cure their disease.
The authors note that doctors often find it hard to deliver bad news to patients, with many finding it “stressful” and “demanding.” They add that many doctors fear they will be blamed for a bad prognosis or that they will destroy a patient’s hope and cause emotional distress.
In addition, delivering a less positive message may make the doctor appear less compassionate toward the patient. “Although modern communication practices emphasize the importance of patients being fully aware of their medical condition, disclosure of less optimistic news was historically considered a potential source of suffering for patients,” the researchers note.
To build on this theory, the team enrolled 100 patients with advanced cancer to their study, before randomizing them to watch two 4-minute videos of an actor depicting a doctor discussing treatment information with a patient who had advanced cancer.
In the first video, the doctor delivered a more optimistic message to the patient, which involved the possibility of future treatment. The second video showed the doctor delivering a less optimistic message, in which the patient was told there were no further treatment options available. In each video, both doctors made five empathetic statements.
After watching each video, the patients were asked which doctor they preferred and to score how compassionate they perceived each doctor to be on a scale of 0-50.
Less optimistic message linked to lower perception of compassion
The researchers found that 57% of patients preferred the doctor who delivered the more optimistic message, while 22% of patients preferred the doctor with the less optimistic message and 21% had no doctor preference.
What is more, patients reported significantly higher compassion scores after watching the video with the more optimistic message, compared with the less optimistic message.
In addition, the doctor who delivered the more optimistic message was also perceived as more trustworthy than the doctor who delivered the less optimistic message.
The authors say their findings may explain why doctors are reluctant to deliver bad news to patients out of fear of being perceived as less compassionate. They add:
“Further research and educational techniques in structuring less optimistic message content would help support professionals in delivering bad news, as well as decreasing the burden of feeling less compassionate in these instances.
At the same time, improved delivery of treatment and prognostic information would enable patients to make a more informed decision.”
In an editorial linked to the study, Dr. Teresa Gilewski, of Memorial Sloan Kettering Cancer Center in New York, NY, says as well as improving understanding of how positive and negative messages delivered by doctors influence patients’ perceptions of compassion, the research “provides an impetus for additional research.”
“For example,” she adds, “would the patient perception be different with an in-person interaction, a longer discussion, a personal relationship with the physician, or at a different time in the patient’s illness? Further research is likely to enhance our understanding of the complexities of compassion in patient care.”