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Year : 2004  |  Volume : 10  |  Issue : 2  |  Page : 64-66

Should a patient with a life threatening illness be informed of the diagnosis? A survey of physicians and medical students in Calicut


Calicut Medical College, Kerala, India

Correspondence Address:
Divya Purakkal
Fourth Year MBBS, L. H. Block - 1, Calicut Medical College, Calicut - 673 008
India
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Source of Support: None, Conflict of Interest: None


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 » Abstract 

AIM: To ascertain how doctors and under graduate medical students in a teaching hospital felt about revealing and knowing the diagnosis of a life threatening illness. MATERIALS AND METHODS: 850 respondents (200 pre clinical students, 300 clinical students, 100 interns, 150 postgraduate registrars and 100 faculty) were interviewed with the help of a set questionnaire. RESULTS: 70% of pre clinical students, 85% of clinical students and 89% of doctors stated that the diagnosis should be revealed. Women preclinical students, (60%), were significantly less in favour of the diagnosis being revealed than other groups. 81% of pre - clinical students, 89% of clinical students, 94% of postgraduates and 95% of faculty would want to know the diagnosis if they themselves were to develop a life threatening illness.


Keywords: Cancer, communication, information needs


How to cite this article:
Purakkal D, Pulassery D, Ravindran S. Should a patient with a life threatening illness be informed of the diagnosis? A survey of physicians and medical students in Calicut. Indian J Palliat Care 2004;10:64-6

How to cite this URL:
Purakkal D, Pulassery D, Ravindran S. Should a patient with a life threatening illness be informed of the diagnosis? A survey of physicians and medical students in Calicut. Indian J Palliat Care [serial online] 2004 [cited 2020 Oct 20];10:64-6. Available from: https://www.jpalliativecare.com/text.asp?2004/10/2/64/13889



 » Introduction Top




A survey conducted by the International Psychooncology Society twenty years ago reported a perceived trend toward increased telling of the diagnosis, greater patient information and expectations, and increased physician openness in using the word cancer. 68% of respondents felt that the overall effect of revealing the diagnosis was positive. (Holland et al 1987)a



However, in many Asian countries popular culture is still against the patient being informed. Tse et al (2003) reported that many Chinese families do not want patients to be informed and physicians often collude with them. One reason for this is the widely held view that truth may be damaging, and that the disclosure of medical facts may destroy a patient's hope or motivation. (Loge et al 1996)



The present study is an attempt to survey how physicians and medical students in Kerala feel about revealing the diagnosis of a life threatening illness to patients and about knowing the diagnosis if they themselves were patients.




 » Materials and Methods Top




The survey was conducted between October and December 2003 at the Calicut Medical College. The study proforma contained two questions:



If your patient is diagnosed to have a life threatening disease such as cancer, do you think it generally necessary to reveal the diagnosis to him or her? Yes/ No



If you were to develop such a disease, would you like to know the diagnosis? Yes / No



Printed questionnaires were handed to 850 respondents. This was a convenience sample comprising of 200 pre - clinical students, 300 clinical students, 100 interns, 150 postgraduate registrars and 100 faculty [Table - 1]. All those approached consented to participate.




 » Results and Discussion Top




81% of the 850 respondents were of the opinion that the diagnosis should be revealed to the patient. A Norwegian study conducted in 1996 similarly found that 81% of 990 physicians were in favour of revealing the diagnosis to the patient. (Loge et al 1996)



70% of pre clinical students, 85% of clinical students and 89% of doctors stated that the diagnosis should be revealed [Table - 1]. The difference between pre - clinical students and people having clinical exposure was attributable to gender. 80% of male students as compared to 60 % of female students thought it necessary to reveal the diagnosis to the patient (Chi square (P < 0.001).



88% percent of respondents wanted to know the diagnosis if they were diagnosed to have cancer. This ranged from 81% for pre - clinical students to 95% for faculty. The gender difference between male and female pre clinical students was not as evident here - 83% of male students and 79% of female preclinical students wished to know the diagnosis.



Even among the 162 people who were not in favour of the diagnosis being revealed, {last columns of [Table - 2] and [Table - 3]} the majority, 63.5% wished to be informed of the diagnosis themselves.



Gautam et al (1987) found that majority of cancer patients wanted to be told the truth. 77% of relatives however felt patients should not be informed.



95% of the 642 respondents who wished to know the diagnosis were also in favour of the patients being informed. Only 43% of those who did not want to know the diagnosis were themselves in favour of revealing the diagnosis to the patient. In the group of those who did not want to know, 15/25 (60%) of clinicians would tell patients, despite their own preference of not knowing, while 49 of 54 medical students were against patients being informed.



Thus, people who were themselves hesitant to be informed seemed to be the group who were averse to patients being informed. It is possible that such professionals may be more hesitant to disclose diagnosis. But since the question was theoretically framed, we cannot be sure about what they would actually do in clinical practice.



There are a few Indian studies reporting the outcome of patients knowing the diagnosis. Chandra et al reported that there was no difference in psychiatric morbidity between patients who were not aware of their diagnosis and those who were. (Chandra et al 1998) 46% of 294 patients in this cancer hospital were unaware of their diagnosis.



Alexander et al (1983) however found that psychiatric morbidity was more common in cancer patients who were aware of their diagnosis and the non-curative intent of treatment. The commonest psychiatric diagnosis, not unsurprisingly was adjustment disorder.



In the light of these individual differences regarding information needs and response to bad news, it remains important for health professionals to check the patient's own wishes regarding disclosure of diagnosis. Medical students and health professionals need to be trained to handle and assess information needs, handle collusion, do bad news interviews and to respect patients' wishes even when these may differ from their personal viewpoint.




 » Acknowledgements Top




We acknowledge with thanks the support by 'Health Action by People', Dr. Sureshkumar and the Institute of Palliative Medicine, and the Department of Community Medicine, Medical College, Calicut.


Tables

[Table - 1], [Table - 2], [Table - 3]



 

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