Many physicians struggle to deliver bad news to cancer patients. They must balance the need to honestly inform patients about their prognoses while expressing empathy. According to new research, cancer patients who are given an optimistic message from their doctors which includes possible future treatment options are more likely to perceive a higher level of physician compassion.
The findings a study which measured doctors’ compassion based on optimism about the possibility of treatment are published online in JAMA Oncology. The study was conducted by Eduardo Bruera, MD and colleagues at the University of Texas MD Anderson Cancer Center in Houston, Texas. The researchers conducted a clinical trial at an outpatient supportive care centre in which 100 patients with advanced cancer viewed videos featuring actors who portrayed physicians delivering news to patients about their prognoses and treatment options.
Two videos were shown to the cancer patients in the clinical trial. One featured a physician delivering a relatively more optimistic message to a patient, including prognostic information along with the possibility of treatment in the future. The other video was less optimistic; the physician was equally empathetic in informing the patient about the prognosis, but did not discuss options for additional treatment.
When asked to score physician compassion, more than half (57 percent) of cancer patients preferred the video in which the physician was depicted delivering the optimistic message. Only 22 percent of patients preferred the less optimistic video, and 21 percent of patients claimed no preference for either physician.
“Our findings suggest that extra support is needed for patients and families and extra care is necessary from physicians when the news is less optimistic as physicians face a challenge to deliver honest prognostic information while still preserving hope,” the authors wrote.
“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,” the study concluded.
In a commentary on the study results which also appears online in JAMA Oncology, Dr. Teresa Gilewski, MD, from Memorial Sloan Kettering Cancer Center in New York said, “Although this unique study advances understanding of the complexities of compassion in medicine, it also provides an impetus for additional research. For example, 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. Yet, one has to wonder whether we have yet to fully appreciate the power of compassion in its simplicity. In an article that focuses on kindness in medicine, Pickering highlights a part in the book 'Oliver Twist' by Charles Dickens. In the story, the beleaguered young Oliver encounters an old lady who ' ... gave him what little she could afford - and more - with such kind and gentle words, and such tears of sympathy and compassion, that they sank deeper into Oliver's soul, than all the sufferings he had ever undergone," said Gilewski.
"Perhaps Dickens understood what medicine at times finds so challenging: the universal and inexplicable nature of compassion at its core," she concluded.
Source: JAMA Oncology
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