Researchers probe physician’s policy of truth in cancer diagnosis

Cancer diagnosis can be a traumatic experience even at the best of times for a patient and often it generates an ethical dilemma for a physician whether to tell the truth or not.

A team of researchers led by Weill Cornell Medical College in Qatar (WCMC-Q) Associate Professor of Public Health in the Division of Medical Ethics, Pablo Rodriguez del Pozo, and physicians from Hamad Medical Corporation and Weill Cornell Medical College in New York looked into the attitudes and practices of physicians in Qatar. The findings are published in the August 2012 edition of The Oncologist, an international digest devoted to medical and practice issues for surgical, radiation, and medical oncologists.

The team of Dr. Pablo Rodriguez del Pozo included Chief of the Division of Medical Ethics at WCMC-New York Dr. Joseph J. Fins, Dr. Ismail Helmy from Hamad, Dr. Ziyad Mahfoud from WCMC-Q and students Rim El Chaki, Tarek El Shazly and Deena Wafadari

This project was made possible by a grant from the Qatar National Research Fund under its Undergraduate Research Experience Program.

Dr. del Pozo said the primary objective of this study was to assess physicians’ policies and practices toward informing patients of their cancer diagnosis. “We also aimed at exploring whether or not physicians’ disclosure policies and practices are associated with their socio-demographic, religious, cultural, and educational backgrounds,” he said.

In their study titled Truth-Telling and Cancer Diagnoses: Physician Attitudes and Practices in Qatar, the researchers found there was is limited information regarding physicians’ attitudes toward revealing cancer diagnoses to patients in the Arab world.

The report highlights that over the past half century, evolving medical ethics has identified the patient’s right to know his or her diagnosis and the physician’s reciprocal duty of disclosure as key elements of the informed consent process. But what began in the United States and has taken deep cultural roots in medical practice, it has not been universally assimilated into medical practices and cultural norms across the globe. In this paper, the researchers emphasized on this evolving practice in the Arabic-speaking world, with a focus on Qatar, which had remained unexplored until now.

They found that there was rather limited information on physicians’ attitudes toward informing patients of cancer diagnoses in the Arabic speaking and Muslim world, although there seems to be a mismatch between what patients prefer and what doctors and families actually do.

“The primary objective of this study was to assess physicians’ policies and practices toward informing patients of their cancer diagnosis. We also aimed at exploring whether or not physicians’ disclosure policies and practices are associated with their socio-demographic, religious, cultural, and educational backgrounds,” Dr. del Pozo said.

The study was cross-sectional in nature, whereby a convenience sample of 131 physicians from nine different Hamad Medical Corporation (HMC) hospitals and outpatient centers were given the study instrument to complete. All 131 physicians surveyed agreed to participate, for a 100% participation rate.

With regard to the central question of truth-telling, a large majority of respondents (88.5%; 95% CI, 81.8%–93.4%) reported that their usual policy was to tell patients of their cancer diagnosis but, notably, a majority also revealed that they would make exceptions in rare cases (66.4%; 95% CI, 57.6%–74.4%). The percentage of physicians who would make exceptions to their policy was significantly higher among physicians whose usual policy was to tell (74.3%) than among those whose usual policy was not to tell (23.1%). Moreover, there was fluidity in their views. A third of respondents said that their policy had changed over the years and about half thought that their policy would probably or certainly change in the future, although they did not specify whether the direction would be more forthcoming or not.

The most frequently reported factors that physicians would take into account when making an exception to truth-telling were the patient’s emotional stability (74.0%), age (68.8%), and perceived intelligence (67.7%). To a lesser extent, the patient’s

sex (26%) and religion (25%) were still considered when making an exception to the truth-telling practice.