Oncologists Struggle Discussing With Patients About Treatment Failure, Drug Cost

by VR Sreeraman on Dec 7 2008 12:12 PM

Oncologists need more guidance to help them talk to their patients about difficult topics such as the cost of medication and treatment failure, according to a study published the latest issue of the Medical Journal of Australia.

Cancer specialists are at risk of burnout from the stress of their work, according to Professor Martin Tattersall of the Centre for Medical Psychology and Evidence-Based Decision Making at the University of Sydney and his colleagues.

“Communicating with patients has been identified as a significant source of stress for these doctors, particularly if they feel inadequately trained for the task,” Prof Tattersall said.

“With cancer specialists conducting an average of 35 bad-news discussions per month, the stress can have an impact on the doctor’s health and the quality of care provided to patients.”

The study showed doctors had the most difficulty discussing high-cost drugs with patients they knew could not afford them and discussing topics relating to treatment failure.

“Only a third of oncologists would discuss a new drug with a patient if the drug was not PBS-subsidised,” Prof Tattersall said.

The study recommends targeted, evidence-based guidelines and communication courses to better equip cancer specialists for discussing unsubsidised high-cost drugs and for offering different forms of hope following treatment failure.

Practice-related sources of stress for oncologists included having incomplete patient information to conduct a consultation or having a long line of patients waiting.

“Implementing small organisational changes, such as reducing interruptions during consultations and informing patients of the duration of their allocated consultation, may also help reduce stressful practice situations,” Prof Tattersall said.

Surprisingly, the doctors surveyed reported the least difficulty with disclosing cancer diagnosis and being honest about the patient’s prognosis.

Prof Tattersall said this is an improvement on findings of a decade ago, suggesting that training in these topics has reduced discomfort.