You know the old saying: Honesty is the best policy. A study performed at the VCU Massey Cancer Center surveyed 27 patients with advanced cancers. The study found that “hope is maintained when patients with advanced cancer are given truthful prognostic and treatment information, even when the news is bad.” Dr. Winokur, a retired oncologist, speaks of the challenge for physicians to tell patients the truth about their prognosis in his post on The Health Care Blog http://www.thehealthcareblog.com/the_health_care_blog/2011/01/why-we-avoid-telling-patients-the-truth.html .
Dr. Winokur reflects in his post, “Rather than fearing that our patients may give up and stop treatment if they knew the truth, I wondered if the real reason why we avoid telling our patients the truth was because, as physicians, we can’t admit to ourselves that we can’t cure our patients or even extend their lives.”
The study indicates that physicians need to find the confidence to tell patients the truth even when the truth is grim. Yes, it’s difficult, but it’s better that a patient know what to expect from the get go then to have surprises later on down the road.
Background: Oncologists often do not give honest prognostic and treatment-effect information to patients with advanced disease. One of the primary reasons stated for witholding this information is to “not take away hope.” We could find no study that tested if hope was influenced by honest clinical information.
Methods: We tested decision-aids in 27 patients with advanced cancer who were facing first-, second-, third-, and fourth-line chemotherapy. These aids had printed estimates of treatment effect and the patient’s chance of survival and being cured (always zero). We measured hope using the Herth Hope Index, which ranks patients’ responses to 12 questions and yields a maximum score of 48.
Results: The scores on the Herth Hope Index did not change and the patients remained uniformly hopeful about their future. The pretest score was 44.2 (SD 3.9), and it increased to 44.8 (SD 3.86; P = .55 by paired Student’s t-test).
Conclusion: Hope is maintained when patients with advanced cancer are given truthful prognostic and treatment information, even when the news is bad.
Post by Dan Dunlop with Stephanie Cohen, UNC-Chapel Hill student and Jennings intern