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
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
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
Disclosure: Dr. Devlin reported no relevant