Giving Honest Information to Patients With Advanced Cancer Maintains Hope
Oncologists often do not give honest prognostic and treatment-effect information to patients with advanced disease, trying not to “take away hope.” The authors, however, find that hope is maintained when patients with advanced cancer are given truthful prognostic and treatment information, even when the news is bad.
Background: Oncologists often do not give honest prognostic and treatment-effect information to patients with advanced disease. One of the primary reasons stated for witholding this information is to “not take away hope.” We could find no study that tested if hope was influenced by honest clinical information.
Methods: We tested decision-aids in 27 patients with advanced cancer who were facing first-, second-, third-, and fourth-line chemotherapy. These aids had printed estimates of treatment effect and the patient’s chance of survival and being cured (always zero). We measured hope using the Herth Hope Index, which ranks patients’ responses to 12 questions and yields a maximum score of 48.
Results: The scores on the Herth Hope Index did not change and the patients remained uniformly hopeful about their future. The pretest score was 44.2 (SD 3.9), and it increased to 44.8 (SD 3.86; P = .55 by paired Student’s t-test).
Conclusion: Hope is maintained when patients with advanced cancer are given truthful prognostic and treatment information, even when the news is bad.
Oncologists often do not give patients honest and truthful information about their prognosis and treatment options,[1-3] despite the fact that many patients say they want candid clinical information even if the outlook is poor.[4] Most cancer patients never receive information from their physicians about prognosis[5] or even imminent death.[6] That lack of knowledge is associated with worse quality of care, worse quality of life (QOL), and worse QOL for the surviving caregivers.[7]
One of the main reasons that oncologists state they do not give patients such information is that they “do not want to take away hope.”[8] We could find only limited information in the medical literature showing the effect of truthfulness on hope, so we tested the effect on hope of decision-aids that provided patients with explicit average benefits of treatment-effect, chance of cure, and survival.
Methods
APPENDIX 1
The Herth Hope Index
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