Primary health care provider perception versus patients' preferences on death and disclosure of poor prognosis
- Author:
Flores Barbara Amity N.
;
Nicodemus Leilanie A.
;
Medina Jr Manuel F.
- Publication Type:Journal Article
- MeSH:
DEATH
- From:
The Filipino Family Physician
2011;49(1):8-16
- CountryPhilippines
- Language:English
-
Abstract:
A systematic review in 2007 on truth-telling in discussing prognosis in terminally ill cases revealed that patients frequently have misunderstandings about their illness prognosis and goals of treatment as a result of poor disclosure practice. A common reason is the reluctance of physicians to communicate bad news, due in part to apprehension as to patient wishes on disclosure and its after-effects. Without proper disclosure, families cannot move towards appropriate decision making on end-of-life care.
As physician lack of awareness to patients' desires is the rate-limiting step in communicating bad news, this study aimed to clarify if primary healthcare providers perception coincide with patients' general preferences on death and disclosure of poor prognosis.
Comparison of primary health care perspectives and patient preferences were based on the following issues on death and disclosure of poor prognosis: acceptance of death as a natural part of the circle of life, desire to accept news of poor prognosis, preference as to the more appropriate person to deliver bad news, desire whether to be told of poor prognosis at the earliest possible time, desire to postpone the discussion of death, and views on maintaining hope in the face of poor prognosis.
Methodology: A cross sectional study was done. The patient population were recruited from those who sought consult at the Family Medicine Clinic. Primary health care providers were represented by PGH residents from the FM and IM departments. One hundred four patients and 52 resident physicians based on the conservative estimate of 1:2 ratio of resident trainee to patients was the calculated sample size. A self-administered survey questionnaire was developed from extensive literature review of various references on end-of-life care. Content validation was done through review of the questionnaire items by an expert panel. Descriptive statistical analysis was done. Coefficient of variation was used to compare patient and primary healthcare provider perceptions. Association of preferences to socio-demographic variables was measured using chi-square test.
Results: A total of 200 patients and 73 primary healthcare physicians were included in the study. Mean age was 46 for patients and 29 for primary health care physicians. Majority of the respondents in both groups were female and of the Catholic faith. Most of the patient respondents were married whereas majority of the physicians were single. Highest educational attainment of the patients is mainly high school. Physician respondents were 37 FM residents and 35 IM residents almost equally distributed by year level. Comparison of patient and primary healthcare provider perspectives revealed significantly different results for accepting death as a natural part of the circle of life and perception that disclosure will destroy hope. This means that the respondents answers to these 2 questions were varied. As opposed to the similar computed values for patients prefer disclosure from a doctor and patients prefer to postpone discussion of death. Association of patient preference to socio-demographic profile is statistically significant for age, gender and educational attainment. Results show that older patients prefer family members to disclose poor prognosis. Male patients do not want to know that they are terminally-ill or dying and patients who only received elementary education do not want to know their prognosis and prefer to avoid discussion of death. Civil status and religion of primary healthcare providers affect their perception. Single physicians believe that patients do not want to know that they are dying, and are less likely to choose family members to deliver bad prognosis.
Conclusion: The study showed that in PGH, primary healthcare providers, perceptions generally coincide with patient preferences, specifically with regards to patients' desire to accept news of poor prognosis, the more appropriate person to deliver bad news, and the desire for disclosure but with preference to postponing discussions of death as much as possible. Varied responses were seen in the question of death being a natural part of the circle of life, reflecting some issues on acceptance of death and dying among patients. Physicians had a diverse response to maintaining hope in the face of poor prognosis, contrary to the almost homogenous patient response that disclosure will not destroy hope. Based on socioodemographic factors: Older patients prefer family members or loved ones to disclose poor prognosis. Male patients prefer not to know that they are terminally-ill or dying. Those who only received elementary education do not want disclosure of poor prognosis and are more likely to postpone discussions of death. It is recommended that these results be kept in mind when disclosure of poor prognosis and death is warranted. The following are also recommended: to correct the misperception of physicians that disclosure of poor prognosis destroy patient hope and more in-depth investigation of the issues tackled, particularly, patient issues behind the acceptance of death as a natural part of the circle of life and the circumstances surrounding patient desire to accept disclosure of poor prognosis and at the soonest time yet wanting to postpone discussions of death as much as possible.
