New Research Patient Empowerment

A Call for Honesty in Medicine

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.

To read Dr. Winokur’s post on The Health Care Blog, click here: http://www.thehealthcareblog.com/the_health_care_blog/2011/01/why-we-avoid-telling-patients-the-truth.html.

To read the VCU study online, go to http://tinyurl.com/4cajhmw. Here is the abstract from that study:

ABSTRACT

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

3 comments on “A Call for Honesty in Medicine

  1. The oncologists position noted above and lack of skill in communicating effectively with patients is well known by family physicians. It sometimes looks as if they are willing to give chemotherapy until three days after the patients funeral. We would love to be given the probabilities they know about the particular treatment strategy for our patients. We would be happy to deliver those probabilities to the patients in the context of our relationship with the patient to help our patients and colleagues. The oncologists that I’ve known over a 37 years in medicine, however, don’t share the care of patients very well. We know that all our patients eventually die and that fact does not kill hope. Our patient’s hope is not dependent on physical survival. That is what they have taught us. They haven’t been as effective in teaching oncologists.

  2. Liz Nettles

    Dr. Atul Gawande touched on this in an excellent article in “The New Yorker” on what medicine should do when it can’t save your life. http://nyr.kr/aoAg3H

  3. Agreed – honesty is the best policy. This is even true in the face of medical errors — see Journal of Internal Medicine study, “Disclosure of Medical Errors: What Factors Influence How Patients Respond?” — http://www.ncbi.nlm.nih.gov/sites/ppmc/articles/PMC1924693/

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