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Conrad Notes
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K. Redmond, MSN, University College Dublin, Ireland, provided supporting documentation to encourage the inclusion of cancer patients in the decision-making process. Patients and healthcare professionals view cancer information sharing differently. Perceptions also differ among doctors and between patients. Acceptance of the patient's basic right to self- determination would lessen the overall impact of cytotoxic treatment. (See related article by Gaisser in this issue of Conrad Notes).

Patient information/participation preferences Cassileth surveyed 256 cancer patients at the University of Pennsylvania Hospital (Ann Int Med 1980;92;832-836). Younger, better-educated persons preferred to receive as much information as possible and to participate actively in treatment decisions. This group showed more hope according to the Beck Hopelessness Scale. Helping patients become well informed, contrary to common belief, assists in sustaining hopeful attitudes, according to Cassileth.
Attitudes to chemotherapy The Slevin study questioned patients with newly diagnosed solid tumors and matched controls, oncologists, general practitioners and cancer nurses (Br Med J 1990;300:1458-1460). Among the study cohort were 100 patients, 100 matched controls, 97 oncologists, 790 general practitioners, and 303 cancer nurses.

One question asked whether the respondent would be willing to have life prolonged for three months by receiving intensive or mild treatment. More patients expressed a willingness to take either treatment compared with controls (42% vs 10% and 53% vs 25%, respectively). Doctors and nurses showed significantly less likelihood to accept therapy under these conditions (p<0.001).

The survey of Bremnes found patients and surgical nurses most reluctant to demand or accept toxic therapy providing minimal or no benefit (Eur J Cancer 1995;31A:1955-1959). Cancer patients under 50 years were significantly more willing to accept the regimen than the controls, oncologists, surgeons, oncology nurses, or surgical nurses.

Communicating with the cancer patient Thomsen surveyed European gastroenterologists using questions related to information sharing (Lancet 1993;341:473-476). About 260 of the 600 distributed questionnaires were completed.

One of the seven queries asked "Would you tell this patient that he/she has cancer, if he/she asks no questions?" Of the 252 responses, there were 104 yes and 148 no. Most northern Europe gastroenterologists would tell the patient while southern and eastern Europe specialists would not.

Another question asked: "Would you tell the patient that the condition is incurable?" In this instance, 207/253 (82%) answered negatively. Most European gastroenterologists, except those in northern countries, would not tell the patient. If told, the doctor tended to embellish the message. In contrast, most of the surveyed gastroenterologists would tell the spouse the full truth about the diagnosis and prognosis.

Presenter conclusions According to Redmond:
  • Patients have a fundamental right to participate in decisions about their therapy.
  • Caregivers cannot make assumptions on patient attitudes and values which often differ.
  • Decision-making, especially in advanced cancer, needs to be shared with the patient.

The impact of cancer and chemotherapy on the patient could be lessened by improved sensitivity to patient-centered factors.

For professional correspondence, please contact Ms. Redmond by E-mail at: redmondk@iveagh.ucd.ie

Eugene A. Conrad

Presented at The European Cancer Conference (ECCO 9), September 14-18, 1997
Copyright © 1997 Conrad Group, Inc. All Rights Reserved
Eugene A. Conrad, PhD, MPH / ISSN 1078-2230 / November 1997
Send comments to: ConradNote@aol.com

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