DO DOCTORS KNOW WHEN THEIR PATIENTS DONT - A SURVEY OF DOCTOR-PATIENTCOMMUNICATION IN LUNG-CANCER

Objectives: a) To determine how much patients with recently diagnosed lung cancer know about their illness and its treatment, and b) to find out if doctors know what their patients know and what they don't. Pat ients and Methods: One hundred patients with recently diagnosed lung c ancer, who were undergoing radiotherapy or chemotherapy, were intervie wed to determine their view of their diagnosis, the extent of the canc er, the intent of treatment, and the risks and benefits of treatment. Their attending physicians' views were elicited contemporaneously, usi ng a self-administered questionnaire. The principle outcome measure of the study was the level of agreement between the views of the patient s and the doctors about the disease, the treatment, and the prognosis. Concordance between doctors and patients' views was expressed in term s of percentage agreement, and Kappa (kappa). Results: Ninety-nine per cent of the patients knew that they had lung cancer. Sixty-four percen t (64%) agreed with their doctor about the extent of the disease (kapp a = 0.48). Most of those who disagreed underestimated the extent of th eir cancer. Seventy-two percent (72%) agreed with their doctor about t he intent of treatment, (kappa = 0.49). Thirty-six percent (36%) agree d with their doctors about their probability of cure, (kappa = 0.17): most of those who disagreed systematically overestimated it. Sixty-eig ht patients were receiving palliative treatment. Of these, 56% agreed with their doctor about the probability of symptomatic benefit (kappa = 0.42), but only 14% agreed with their doctor about the probability t hat the treatment would prolong life (kappa = 0.06). Doctors frequentl y failed to recognize their patients' misconceptions about the intent of treatment and the prognosis. Conclusion: Many patients did not unde rstand their situation well enough to make a truly autonomous treatmen t decision, and their doctors often failed to recognize this. (C) 1997 Elsevier Science Ireland Ltd.