Prevelance and determinants of diagnostic and prognostic disclosure by radiotherapists and surgeons to patients with terminal cancer in Hong Kong

Abstract

This paper identifies the prevalence and determinants of diagnostic and prognostic information given to terminally ill cancer patients in Hong Kong. Surgeons and radiotherapists (n = 153) were interviewed about the information they gave to their most recently deceased cancer patients. This was explored in relation to doctors' and patients' demographic data, diagnosis, the stage of disease at disclosure, and doctors' attitude. Diagnostic information was disclosed partially in 68% and fully in 46% of cases. Prognosis was disclosed partially in 38% and fully in less than 10% of cases. Determinants of diagnostic disclosure included doctors' attitudes about death, and perceived responsibility for disclosure. The doctor's training and work, and the patient's request for information determined the level of disclosure. After adjustment for a number of social and demographic factors, only the patient's education level remained a significant determinant of the level of prognostic disclosure. A significant proportion of terminally-ill cancer patients do not engage in discussion of diagnosis or prognosis with the doctor caring for them during the last stages of their disease. This reflects the unwillingness to discuss such matters, giving a low priority to information provision, paternalism or other factors, such as little importance being attached to such topics at the late stage of cancer. Thus many cancer patients may fail to learn important information about their disease if they have not engaged in discussion of these topics earlier in their illness. The results of this paper have important implications for medical education in caring for patients with cancer.