Good piece on how the optimism bias, and doctor communications, result in more chemo and poorer quality of life in cases of terminal cancer. Elaborates further on earlier post Cancer patients may misunderstand goal of chemo.
….if a patient is under the impression that chemotherapy might cure advanced cancer, then is offering chemotherapy to that patient ethical, under the principles of informed consent? Such thinking reflects a lack of accurate information, so consenting to treatment could only be seen as uninformed.
Maybe. The survey also raises questions about how well physicians are doing at having the most difficult of conversations. As Smith and Longo write in their accompanying editorial:
“Truthful conversations that acknowledge death help patients understand their curability, are welcomed by patients, and do not squash hope or cause depression. We need help breaking bad news. This is not one hard conversations for which we can muster our courage but a series of conversations over time from the first existential threat to life.” …..
Clearly patients themselves are also responsible for understanding the reality of the treatment they are seeking. The authors raise an intriguing point about “collusion” between patients and physicians, where the discussion moves too quickly from the facts of the prognosis to the potential treatment options, a phenomenon reported in this study from 12 years ago exploring the reasons behind false optimism about recovery among cancer patients.
The editorial also highlights the stubborn clinging to an inaccurate belief about chemotherapy. “When patients are given their actual prognosis, one third or more will not admit that treatment will not cure them,” Smith and Longo write, citing two studies on the matter (this one [on which Smith is first author] and this one).
As Weeks and colleagues note, the primary concern with inaccurate expectations about chemotherapy for late-stage cancer is that they can get in the way of dying well. End-of-life planning takes time and thorough, honest conversations. If someone is holding onto hope of a cure, such conversations are far more difficult if not impossible.