E. Bruera et al., Attitudes and beliefs of palliative care physicians regarding communication with terminally ill cancer patients, PALLIAT MED, 14(4), 2000, pp. 287-298
The subject of communication between palliative care physicians and their p
atients regarding their diagnosis and prognosis has not been extensively re
searched. The purpose of this survey was to compare the attitudes and belie
fs of palliative care specialists regarding communication with the terminal
ly ill in Europe, South America, and Canada.
A sample of palliative care physicians from South America (Argentina and Br
azil), French-speaking Europe, and Canada were identified, and posted a que
stionnaire. Physicians who stated that they practised palliative ca re at l
east 30% of their time were considered evaluable as palliative care special
ists.
Of a total of 272 questionnaires, 228 were returned (84%); and 182/228 (81%
) respondents were considered to be palliative care specialists. Palliative
care physicians in all three regions believed that cancer patients should
be informed of their diagnosis and the terminal nature of their illness. Ph
ysicians reported that at least 60% of their patients knew their diagnosis
and the terminal stage of their illness in 52% and 24% of cases in South Am
erica, and 69% and 38% of cases in Europe, respectively. All physicians agr
eed that 'do not resuscitate' orders should be present, and should be discu
ssed with the patient in all cases. While 93% of Canadian physicians stated
that at least 60% of their patients wanted to know about the terminal stag
e of their illness, only 18% of South American, and 26% of European physici
ans said this (P < 0.001). Similar results were found when the physicians w
ere asked the percentage of families who want patients to know the terminal
stage of their illness. However, almost all of the physicians agreed that
if they had terminal cancer they would like to know.
There was a significant association between patient based decision-making a
nd female sex (P = 0.007), older age (P = 0.04), and physicians from Canada
and South America (P < 0.001). Finally, in their daily decision making, So
uth American physicians were significantly more likely to support beneficen
ce and justice as compared with autonomy. Canadian physicians were more lik
ely to support autonomy as compared with beneficence.
In summary, our findings suggest that there are major regional differences
in the altitudes and beliefs of physicians regarding communication at the e
nd of life. More research is badly needed on the attitudes and beliefs of p
atients, families, and health care professionals in different regions of th
e world.