title: [A survey of neurosurgeons' policies and attitudes regarding the disclosure of a diagnosis of glioma and the decision to pursue end-of-life care in glioma patients].
abstract: OBJECTIVE
  Patients with malignant gliomas have an even worse prognosis than other cancer patients, and they sometimes undergo surgery and chemo-radiotherapy without having been informed of the nature of the disease and its prognosis in Japan. Often, patients with glioblastoma are only told that they have a brain tumor, although other family members are told of the real diagnosis and prognosis. Since patients with glioblastoma, often experience a rapid deterioration in their condition, they usually do not have enough time to seek a second opinion regarding their disease. We surveyed neurosurgeons in Japan with regard to their policies and attitudes concerning the disclosure of a diagnosis of glioma and their thoughts on the end-of-life care of glioma patients.
  
  
  METHODS
  A survey was performed in November, 2007. A questionnaire was sent by e-mail to 259 participants who planned to attend the 25th Brain Tumor Conference in Japan.
  
  
  RESULTS
  One hundred and thirty-two participants (51%) returned the questionnaire. Almost all the respondents were neurosurgeons specializing in malignant brain tumors. The percentages of respondents who informed their patients of a diagnosis of grade 2 astrocytoma, grade 3 or grade 4 glioblastoma were 73%, 57% and 37%, respectively. More than 80% of all glioblastoma patients were only told that they had a malignant brain tumor. Sixty-eight percent of the doctors told the family members, but not the patients, of the real diagnosis. The neurosurgeons' policies and attitudes toward end-of-life care for patients with gliomas were also analyzed.
  
  
  CONCLUSIONS
  Most neurosurgeons have difficulty disclosing a diagnosis of glioma and providing end-of-life care. This survey will help to develop guidelines regarding disclosure and the decision to pursue end-of-life care for patients with gliomas. (Received : March 19, 2009, Accepted : June 8, 2009)
authors.affiliation: Neurosurgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Narita
authors.forename: Yasuji
authors.initials: Y
authors.lastname: Miyakita
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Momota
authors.forename: Ruriko
authors.initials: R
authors.lastname: Miyahara
authors.forename: Soichiro
authors.initials: S
authors.lastname: Shibui
mesh_terms: D001291:Attitude of Health Personnel; D001932:Brain Neoplasms / Q000628:therapy*; D003625:Data Collection; D005910:Glioma / Q000628:therapy*; D006801:Humans; D007564:Japan; D009493:Neurosurgery; D013727:Terminal Care; D014342:Truth Disclosure