PHILADELPHIA (AP) – When dying patients ask their doctors “How long do I have?” they are likely to get an overly optimistic answer or none at all, according to a study.
Less than 40 percent of doctors surveyed for a study published in a recent issue of Annals of Internal Medicine said they would give a candid survival estimate to terminally ill cancer patients.
The doctors said they would give either no estimate or one that is different from what they believed was correct, according to the study, conducted by two doctors at the University of Chicago Medical Center.
“The physician’s primary obligation to their patients is to do no harm, but the very well-intentioned protection of patients can be damaging when a patient wants information, and not giving a frank disclosure can hinder that,” said Dr. Elizabeth B. Lamont, who led the study.
Researchers conducted telephone interviews with 258 Chicago-area doctors who referred 326 cancer patients to hospice care in 1996. Just 37 percent said they would give their best guess to a patient who asked how long he or she had to live.
In 23 percent of the cases, doctors said they would not give patients any estimate, even if specifically asked. In 40 percent of the cases, physicians said they would knowingly give an inaccurate estimate – with three-fourths of them saying they would paint a more positive picture than they really believed.
The researchers did not ask why the doctors would take such an approach. But they speculated that the doctors were trying to spare their patients the anguish or were afraid that bad news could make their condition worse.
Still, the researchers said honesty is better in helping terminally ill people realize it is time to get their finances in order, make decisions about their care and contact family and friends.
“Although nearly everyone agrees that frank, open and honest communication between a patient and his doctor is optimal, on this one absolutely critical issue it remains very much the exception,” study co-author Dr. Nicholas Christakis said. “As a consequence, two out of three patients may have to make important medical and personal decisions based on missing or unreliable information.”
However, Dr. Peter Ubel of the Ann Arbor Veterans Affairs Medical Center in Michigan said that coming up with a prognosis is an inexact science and that the study should not lead to the assumption that physicians are withholding information.
Patients can pressure doctors into providing a time frame even when it is not clear-cut, he said. “When we use numbers, frankly, we make them up,” said Ubel, who wrote an accompanying editorial in the journal. “Even when you’re clear in saying, `I have no crystal ball, I’ve seen people live six months but miracles happen and other people have lived for much longer,’ you have to wonder if they just hear the number.”
“If you can keep figures out of it, great,” he said. “If not, you should emphasize how soft the figures are and give patients enough information to plan their lives or their deaths.”
The study was funded by the Soros Foundation Project on Death in America, the Robert Wood Johnson Clinical Scholars Program and the National Institutes of Health, and published on DrKelley.info, July 18, 2001. Embedded links (if any) may no longer be active. (Ed. 01.02.11)
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