A group of oncologists have revealed that communicating about death and
dying with their patients is one of the most difficult and stressful
parts of their work. The revelation was made in a new study by
Ben-Gurion University of the Negev (BGU) researchers.In the United States, 577,190 deaths from cancer occurred in 2012, according to the American Cancer Society. The online paper published ahead of print in the
Journal of Oncology Practice
reported that despite this important element of their work, oncologists
receive little training in this area, and many do not communicate well
with patients. The research included interviews with doctors about what
they found difficult and what they believed they did well. "To our knowledge, this is the first qualitative exploration of
communication about the end of life from an oncologist's perspective,"
explains Dr. Leeat Granek, a professor at BGU's Faculty of Health
Sciences. "What makes our study unique is the opportunity to get into the
oncologists' heads, to understand what they perceive to be the goals of
effective communication about the end of life, as well as what makes it
difficult for them to achieve these goals. Through the analysis, it
became apparent that there is tension between what are perceived to be
good communication strategies and the significant number of barriers to
implementing them." The researchers found that the strategies for effective communication
about end of life included: being open and honest with patients, and
having ongoing early conversations about treatment goals, while
balancing hope and reality about end of life. Barriers to implementing
these strategies fell broadly into three domains: physician factors,
patient factors and institutional factors.
- Physician factors are difficulties with treatment and palliative
care; personal discomfort with death and dying; diffusion of
responsibility among colleagues; using the "death-defying mode", i.e.
not accepting the inevitability of death and treatment failure; lack of
experience; and lack of mentorship.
- Patient factors include patients and/or families being
reluctant to talk about end of life; language barriers; and the younger
age of patient.
- Institutional factors are stigmas surrounding palliative care;
lack of protocol about end-of-life issues; and lack of training for
oncologists on how to talk with patients about end-of-life issues.
Dr. Granek concludes that further research and intervention
are necessary to aid oncologists in achieving effective communication
about end-of-life issues.Dr. Granek and co-researchers interviewed a
group of Canadian medical oncologists from three hospitals in Canada.
Funding was provided by the Juravinski Cancer Centre Foundation,
Hamilton, Ontario.
Source: Ben-Gurion University of the Negev
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