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Poster Numbers 46 to 64 – Ethics, education & communication: Poster No: 48
Qualitative study on Thai physicians prognostic disclosure to patients with advance-staged cancer
  1. Ninlawan Nimmanworawong,
  2. Darin Jaturapatpon and
  3. Saipin Hathirat
  1. Department of Family Medicine Ramathibodi Hospital Mahidol University, Bangkok, Thailand

Abstract

Background Physicians who take care of advance-stage cancer patients always face the question ‘Doc, how much time do I have left?’ which make them feel awkward to answer the question.

Purpose To understand how Thai physicians disclose prognosis to advance-staged cancer patients

Designs and methods A qualitative indepth interview with purposeful sampling was conducted among 15 residents from six different departments in Faculty of Medicine, Ramathibodi Hospital from January to February, 2011. Content analysis was performed independently by three researchers.

Results There were five attitudes that affected the prognosis disclosure in advanced-stage cancer patients including perceptions of inadequate skill and competency, attitudes toward prognosis in case of their own cancer diagnosis, attitudes toward own concepts of medical professionalism, attitudes toward death and attitudes toward prognosis disclosure in different groups of Thai patients. All five attitudes affected the feeling of each physician which in turn lead to the way physicians formed patterns in prognosis disclosure. Furthermore, prognosis disclosure patterns depended on the following factors including doctors, patients, doctor-patient relationship and working settings. There were several forms of prognosis disclosure, for example, obscure disclosure, ‘range of time’ disclosure,'exact time' disclosure, ‘statistical and technical-term’ disclosure, and patient-centred disclosure. However, some physicians chose to answer in either an optimistic or pessimistic way based on their own opinions. Some physicians disclosed relatives their actual estimation, but gave patients better hope, while some physicians only told relatives without discussing with patients.

Conclusion Prognosis disclosure in advance-staged cancer patients is a challenge for Thai physicians. Different styles in prognostic disclosure were not only from physicians' attitudes, patients' status, but also the relationship between doctor and patient.

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