What oncologists tell patients about survival benefits of palliative chemotherapy and implications for informed consent: qualitative study

doi:10.1136/bmj.a752

Published 31 July 2008, doi:10.1136/bmj.a752
Cite this as: BMJ 2008;337:a752

Research

What oncologists tell patients about survival benefits of palliative chemotherapy and implications for informed consent: qualitative study

Suzanne Audrey, research associate¹, Julian Abel, consultant in palliative care², Jane M Blazeby, professor of surgery and honorary consultant surgeon³^,4, Stephen Falk, consultant clinical oncologist⁵, Rona Campbell, professor of health services research¹

¹ University of Bristol, Department of Social Medicine, Bristol BS8 2PR, ² Weston Area Healthcare Trust, Uphill, Weston-super-Mare, BS23 4TQ, ³ University of Bristol, Clinical Sciences at South Bristol and Department of Social Medicine, Bristol BS8 2PR, ⁴ Divison of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol BS2 8HW , ⁵ Bristol Haematology and Oncology Centre, University Hospitals Bristol NHS Foundation Trust, Bristol BS2 8ED

Correspondence to: S Audrey Suzanne.Audrey{at}bristol.ac.uk

Objective To examine how much oncologists tell patients aboutthe survival benefit of palliative chemotherapy during consultationsat which decisions about treatment are made.

Design Qualitative study in which consultations were observedand digitally recorded.

Setting Teaching hospital and district general hospital in southwest England.

Participants 37 patients with advanced non-small cell lung cancer(n=12), pancreatic cancer (n=13), and colorectal cancer (n=12);and nine oncologists, including four consultants and five registrars.

Main outcome measures All recordings were transcribed completely,anonymised, and electronically coded with ATLAS.ti. Constantcomparison was used to identify themes and patterns. The frameworkmethod of data management, in which data were charted, was usedto aid transparency of interpretation.

Results During the consultations, information given to patientsabout survival benefit included numerical data ("about fourweeks"), an idea of timescales ("a few months extra"), vaguereferences ("buy you some time"), or no mention at all. In mostconsultations (26/37) discussion of survival benefit was vagueor non-existent.

Conclusions Most patients were not given clear information aboutthe survival gain of palliative chemotherapy. To aid decisionmaking and informed consent, we recommend that oncologists sensitivelydescribe the benefits and limitations of this treatment, includingsurvival gain.

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