dr.ssa Carola Locatelli

Physicians’ age and sex influence breaking bad news to elderly cancer patients

the G.I.O.Ger study

 Introduction:

The debate on the importance of an effective communication in clinical oncology is a main issue for current biomedical ethics. Few studies, however, have specifically addressed the problem of breaking bad news to the elderly from the physician’s perspective. In the past, the general belief was that bad news was detrimental for the patient and could lead to increased psychological distress, thus supporting the practice of nondisclosure.

At the moment, socio-cultural changes in parallel with modern advancements of obtaining medical information through media, web and so on have progressively outdated such a paternalistic approach. Different studies have highlighted the patients’ request towards a more personal approach in understanding their illness as well as the importance of their participating role [1–3]. International literature data show that patientcentred consultation, based on tailored and empathetic communication, lead to improve treatment compliance [4] and patient satisfaction [5], by promoting better awareness of the disease and treatment options [6–9]. Furthermore, despite a global trend towards providing clinical information, numerous reports show relevant cultural differences in truth-telling attitudes and practices in different countries. Cultural differences influence the different roles of family in the information and decision-making process and affect individual views of the patient–doctor relationship [10–17]. Over the past 10 years, signs of change towards a more open disclosure of the truth telling to cancer patients have been reported in countries, including Italy, previously known to have a paternalistic vision of the patient–doctor relationship and to attribute a protective role to family ties with respect to the ill person [18–22]. Today, more information is given to Italian cancer patients by using the most updated communication tools; informed consent is now a legal and deontological requirement for Italian physicians. However, there is still consistent data showing the persistent
practice of giving patients partial or no information about their illnesses, especially when the patient is elderly [23–26]. The modalities of family involvement are different: in some countries, families are consulted before revealing the diagnosis to patients, and/or they make a decision in place of uninformed patients. [18,27]. This approach can be explained by the central role of a protective behaviour played by the family members. Italy and parts of Asia were among such countries [28–34]. In these countries, there is still a widespread physicians’ habit of disclosing cancer diagnosis to the patient’s relatives first.

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