Cancer patients perceived a higher level of compassion and preferred physicians when they provided a more optimistic message in a clinical trial that used videos with doctors portrayed by actors, according to a study published online by JAMA Oncology.1
Information about treatment options and prognosis is essential for patient decisions at the end of life. Physicians frequently have difficulty delivering bad news and many physicians find this process stressful and demanding, according to the study background.
Eduardo Bruera, M.D., of the University of Texas MD Anderson Cancer Center, Houston, and coauthors examined patient perceptions when actors depicting physicians delivered a more optimistic message that included the possibility of future treatment compared with an equally empathetic but less optimistic message that included information about the lack of further treatment options. The study included 100 patients with advanced cancer at an outpatient supportive care center in Houston.
Patients reported scores reflecting higher physician compassion after viewing the more optimistic video compared with the less optimistic video. More patients (57 percent) preferred the physician delivering the more optimistic message, 21 percent of patients had no physician preference and 22 percent preferred the physician with the less optimistic message, according to study results.
“Our findings suggest that extra support is needed for patients and families and extra care is necessary from physicians when the news is less optimistic as physicians face a challenge to deliver honest prognostic information while still preserving hope. … Further research and educational techniques in structuring less optimistic message content would help support professionals in delivering bad news, as well as decreasing the burden of feeling less compassionate in these instances. At the same time, improved delivery of treatment and prognostic information would enable patients to make a more informed decision,” the study concludes.
In a related commentary 2, Teresa Gilewski, M.D., of Memorial Sloan Kettering Cancer Center, New York, writes: “Although this unique study advances understanding of the complexities of compassion in medicine, it also provides an impetus for additional research. For example, would the patient perception be different with an in-person interaction, a longer discussion, a personal relationship with the physician, or at a different time in the patient’s illness?”
“Further research is likely to enhance our understanding of the complexities of compassion in patient care. Yet, one has to wonder whether we have yet to fully appreciate the power of compassion in its simplicity. In an article that focuses on kindness in medicine, Pickering highlights a part in the book ‘Oliver Twist’ by Charles Dickens. In the story, the beleaguered young Oliver encounters an old lady who ‘ … gave him what little she could afford – and more – with such kind and gentle words, and such tears of sympathy and compassion, that they sank deeper into Oliver’s soul, than all the sufferings he had ever undergone,” Gilewski continues.
“Perhaps Dickens understood what medicine at times finds so challenging: the universal and inexplicable nature of compassion at its core,” the author concludes.
1. JAMA Oncol. Published online February 26, 2015. doi:10.1001/jamaoncol.2014.297.
2. JAMA Oncol. Published online February 26, 2015. doi:10.1001/jamaoncol.2014.296.