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Open, Honest Talk about Death Does No Harm

Monday, December 04, 2017

silhouette of two faces looking at each other with words inscribed in the faces

Talking through bad news can be good for the doctor-patient relationship—debunking a common myth among patients, according to a study co-authored by the University of Rochester Medical Center’s Wilmot Cancer Institute.
 
Researchers, in fact, cited an example of a difficult question from an actual conversation in an oncologist’s office: “Have you had thoughts about stopping the chemotherapy and focusing more on comfort and quality of life?”  Patients who took part in honest discussions, including questions like that one from their doctors about prognosis and end-of-life care, rated their doctor-patient relationships more favorably than patients who had fewer discussions about prognosis.
 
The results are somewhat surprising because other studies have shown the opposite, that talking about life expectancy can disrupt the doctor-patient relationship, said co-author Ronald Epstein, M.D., a University of Rochester professor of Family Medicine, Psychiatry, and Oncology, and an expert on physician communications.
 
The findings were recently reported in the Journal of Clinical Oncology. The study also suggests that to keep the relationship healthy, physicians may need to understand the patient’s hopes and emotions, apply tact and skill in sharing information, and be sensitive to timing.  High-quality communication delivers information accurately without undermining patients’ hopes for the future, the study said.
 
The investigation was conducted in collaboration with a team of scientists from the University of California, Davis. This study is one in a series in a UR-UC Davis partnership that uses consented audio recordings of real interactions between patients and doctors in western New York and in northern California. In this case, 265 patients seen by 38 oncologists agreed to participate in the research. All patients had advanced cancer, defined as either stage 4 disease or stage 3 cancers with a relatively short life expectancy.
 
Read the full study here. The National Cancer Institute funded the research with grants to Epstein and UR co-author Paul Duberstein, Ph.D., a professor of Psychiatry, Medicine, and Family Medicine who has a special interest in the role of anxiety in cancer care. Additional Rochester co-authors are Kevin Fiscella, M.D., M.P.H., and Supriya Mohile, M.D., M.S.

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