Collusion in doctor-patient communication about imminent death: an ethnographic study
Many cancer patients develop a "false optimism" about their recovery, as a result of collusion between doctor and patient, which allows them not to acknowledge the long term consequences of the illness, finds a study in this week's BMJ.
Researchers in the Netherlands observed 35 patients with untreatable small cell lung cancer, from initial diagnosis to their death, to explore the reasons why virtually all these patients showed a false optimism about their recovery.
They found that, although doctors did not withhold information from patients, consultations were almost entirely restricted to discussing treatment activities, such as planning chemotherapy sessions and discussing test results. Both parties colluded in focusing on the short term "treatment calendar" and ignoring the long term prognosis, say the authors. This optimism helped patients and their relatives to endure the treatment phase but, in hindsight, most of them regretted this as it obstructed "saying farewell" in time and making necessary arrangements, add the authors.
Breaking this cycle of collusion between doctor and patient requires an active, patient oriented approach from the doctor, say the authors. They conclude that solutions have to be found outside the doctor-patient relationship, for instance by involving "treatment brokers."
Contact:
Anne-Mei The, Institute for Research in Extramural Medicine, Amsterdam, Netherlands
Email: am.the.emgo@med.vu.nl