The physician-patient relationship in treatment decision making at the end of life: a pilot study of cancer patients in a Southeast Asian society.
BACKGROUND
The traditional relationship between patient and physician in East Asian society has often been described as "paternalistic." However, in an increasingly Westernized world, our knowledge of how patients perceive the role of the physician in their decision making regarding treatment is lacking.


OBJECTIVE
This article is part of a larger pilot study exploring the patient-physician dynamic on decision making among Southeast Asian palliative cancer patients. We explore: (1) influence of physicians, (2) the effect of symptom control and quality of life, and (3) dynamics and communication of physicians.


METHODS
An interviewer-administered questionnaire was distributed, with 18 questions related to physician-patient interactions asked. Most questions followed a three point scale: "agree," "neutral," and "disagree," and spontaneous answers beyond this framework were recorded.


METHODS
Thirty patients from the palliative care service were interviewed, including inpatients at Singapore General Hospital and those attending outpatient clinics at the National Cancer Centre.


RESULTS
Patients said that they themselves and their physicians were the main influences (80% each), over family members (48.3%). Some patients (26.7%) felt that symptoms were not well controlled, and 42.9% identified low mood or anxiety. Some patients (44.8%) felt that their condition had an effect on decision making. Most patients (89.3%) had a good relationship with the staff, with >80% being comfortable with discussions held. However, 20.7% of patients felt dissatisfied with the information provided, and 62.1% of patients wanted full disclosure of information.


CONCLUSIONS
Patients appeared to place highest regard in both autonomy and physician input in making decisions, accompanied by an increased desire for more information. These reflect deviation away from traditional thinking of paternalistic doctoring in East Asia.
Singapore General Hospital, National Cancer Centre, Singapore. marc.ho@mohh.com.sg
Zheng Jie
ZJ
Marc Ho
Lalit Kumar Radha
LK
Krishna
Cynthia
C
Goh
Chung Pheng
CP
Alethea Yee
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D003657:Decision Making; D005260:Female; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D010045:Outpatients / Q000706:statistics & numerical data; D010166:Palliative Care; D010332:Paternal Behavior; D010358:Patient Participation; D010817:Physician-Patient Relations; D010865:Pilot Projects; D011788:Quality of Life; D012846:Singapore; D011795:Surveys and Questionnaires; D013727:Terminal Care; D055815:Young Adult