More than two-thirds of oncologists lack confidence when dealing with grieving families

Issue: November 10, 2011

2011 ASTRO Annual Meeting

MIAMI - Results from an online survey of 162 cancer-treating physicians showed that nearly 70% regularly reached out to families following a patient's death, but those same physicians said they had not gotten enough training on dealing with bereavement.

Aaron S. Kusano, MD, a radiation oncology resident at the University of Washington School of Medicine in Seattle, presented the results Monday at the 2011 ASTRO Annual Meeting and said more physicians reached out to families than he expected, but researchers suspected that could have been the result of self-selection among respondents.

"Our study does highlight there is a wide variety of practices by individual physicians when a patient dies," Kusano said. "In addition, these results show that there really is a need to improve our training programs in preparing physicians to have these discussions."

Researchers sent an anonymous online pilot survey to 856 attending radiation oncologists, medical oncologists, surgical oncologists and palliative care physicians in Alaska, Idaho, Montana, Oregon and Wyoming who were directly involved in patient care. A total of 192 of 856 (22.4%) physicians contacted participated in the online survey, and 162 (18.9%) met study inclusion criteria.

Nearly two-thirds of respondents said they became emotionally attached to patients. Overall, 69% (95% CI; 62.0%-76.3%) of respondents reported always or usually calling families, sending a condolence letter (60%), a call to family or caregivers (28%) or attending a funeral service following a patient's death (4%). About one in five respondents (18%; 95% CI, 12.0%-23.8%) reported performing at least one of these activities sometimes. Only 12% (95% CI, 6.8%-16.7%) rarely or never did at least one of these activities.

However, relatively few respondents felt confident when faced with grieving families. A total of 68% of respondents (95%CI, 61.4%-75.7%) said they did not feel that they had gotten adequate training on bereavement during their residency or fellowship training.

Among physicians who did not initiate bereavement follow-up, 90% said they were routinely available if called by a patient's family.

The most common perceived barriers to bereavement follow-up were lack of time and uncertainty of which family member to contact. Additionally, physicians were less likely to follow up when they were unsure of what to say or felt they lacked bereavement support resources.

Medical oncologists were slightly more likely to perform follow-up compared with radiation oncologists and palliative care physicians, though the study was underpowered to detect a difference. Physicians who had access to a palliative care program or who felt the responsibility to write a condolence letter were also more likely to follow-up. - by Jason Harris

For more information:

Kusano AS. #2749. Presented at: 2011 ASTRO Annual Meeting; Oct. 2-6, 2011; Miami.

Disclosure: Dr. Kusano reported no relevant financial disclosures.

What is needed is a full ability for compassionate care that covers the patient and the family, and covers the patient during life and the family during life and death. When we're reaching out at that level, we're reaching out to the depths of any human soul. We could ask, how does one train the human soul? It's beyond the scope of most medical papers to give a good answer and perhaps beyond the right of any human to try to answer, but in many things we do we can model good behavior. We can spend time and focus offline first with some previously successful practices, we can mentor and guide physicians through their early experiences with losing patients and we can coach physicians as they go forward. Peer support, coaching, case-based studies, offline work are some of the elements that need to be emphasized.

- Phillip M. Devlin, MD
ASTRO Secretary/Treasurer

Disclosure: Dr. Devlin reported no relevant financial disclosures.

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