Attitudes and beliefs of palliative care physicians regarding communication with terminally ill cancer patients

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.