Honest Communication With Your Healthcare Provider

A response to: Mack, J. and Smith, T. “Reasons Why Physicians Do Not Have Discussions About Poor Prognosis, Why It Matters, and What Can Be Improved” Journal of Clinical Oncology, Vol 30, 2012

Unfortunately, it is common practice for physicians to wait for the patient to ask for specific information regarding health care diagnosis and prognosis. Ironically, patients wait to be told by their physician what to expect and understand about their illness, resulting in a lack of transmission of important information.

This article highlights the main misconceptions that some health care professionals hold and why they are hesitant to divulge information about health care prognosis, especially when serious illness is involved. Although this article focuses on the physician perspective, there are important takeaways for patients as well. It is essential for providers to be comfortable and competent in having these important conversations. It is equally essential for patients and families to be their own advocates and ask their physician for transparent dialog.

The following are the highlighted myths some, but certainly not all, physicians carry and observations that address the gap:

• Physicians feel that discussing end of life issues will cause depression

It is important for providers and patients to have conversations about how much information patients and families desire to know. The unknown is often more scary and depressing than having the knowledge of what to expect and prepare for. Statistically speaking, “patients who reported having end-of-life discussions had no higher rates of depression or worry.”

• Physicians feel that discussing poor prognosis will take away a patient’s hope

An honest and transparent relationship between patient and provider has proven to support continued hope. It is important for the patients to ask their providers to be forthcoming and direct and for providers to recognize that by avoiding disclosure of relevant medical information, patients are often left in a situation of fearing the unknown. “Evidence suggests that hope is maintained even with truthful discussions…” and “that physician honesty, even about difficult news, may actually help patients to feel more hopeful.”

• A physician-held belief is that involving Hospice or Palliative Care will result in reduced survival

Interestingly, “Many studies suggest that survival is equal or even better with hospice or palliative care.” And, “Palliative care is associated with equal or improved survival in multiple randomized controlled trials.” By acknowledging the stigma and misconceptions that are attached to the terms hospice and palliative care, an open dialog between patient and provider can begin. It is important that these programs are understood and discussed in regards to a patient’s quality of life and potential increased length of life.

• Physicians are hesitant to provide any prognosis as nothing is ever certain

Although physicians cannot predict the future and offer 100% guarantee on any prognosis, they are “often able to formulate a reasonable prognosis or range of possible outcomes that can bring the patient’s understanding closer to the truth.” Patients can insist on being informed of what the provider does know, e.g., what is the expected course of illness?, does the treatment aim to cure the disease or prolong life?, etc.

• Physicians feel that talking about prognosis is not culturally appropriate

“It is true that patients of different ethnic and cultural backgrounds often have different preferences for information…However, knowledge of different preferences by ethnicity should not dictate communication with individuals.” Every person is their own advocate and definer of what is appropriate and it is important for the patient to set the tone for open communication.

• Physicians admit that they do not like having hard conversations as it is personally difficult

Physicians “find breaking bad news to be stressful, and few find it satisfying.” It has even been found that “physicians who have long-term relationships with patients are most likely to overestimate survival.” However, patients have a right to know as much medical information as they want to and by encouraging honest conversation, patients can hold their physicians accountable, which can result in the divulgence of necessary information.

Patients have the right to be informed and able to discuss their prognosis with their health care providers. Unfortunately, when important conversations are avoided, “patients lose good time with their families and for reflection and spend more time in the hospital and intensive care units.” By acknowledging and addressing these common misconceptions, physicians and patient can both feel more empowered to address these topics.