title: Physicians' attitude toward recurrent hypercalcemia in terminally ill cancer patients.
abstract: BACKGROUND
  There is no consensus regarding whether cancer-induced hypercalcemia should be treated up until the patient's death. The primary aim of this study was to clarify physicians' attitude toward treating recurrent hypercalcemia in terminally ill cancer patients and associated factors.
  
  
  METHODS
  A nationwide, cross-sectional survey was performed involving 757 physicians of the Japanese Society for Palliative Medicine. Physicians' attitude toward treating hypercalcemia in terminally ill patients was assessed based on the response to the question: do you agree that you provide medical treatment for recurrent hypercalcemia up until a patient's death? As the potential determinants of physicians' attitudes, we examined their characteristics, beliefs about hypercalcemia, and beliefs about a good death.
  
  
  RESULTS
  We obtained a total of 380 (50.2%) analyzable responses. A total of 163 physicians (43%) agreed that hypercalcemia should be treated up until the patient's death, while the remaining 217 physicians (57%) disagreed. The independent determinants of the attitude included the following: physicians' specialty, belief that hypercalcemia treatment improves pain, belief that hypercalcemia treatment improves nausea, belief that hypercalcemia treatment improves quality of life, belief that hypercalcemia treatment prolongs life, belief that the effect of hypercalcemia treatment reduces gradually, belief that death with hypercalcemia is less distressing, and the perception that being mentally clear is important for a good death.
  
  
  CONCLUSIONS
  Japanese physicians had different attitudes toward treating hypercalcemia in terminally ill patients. Physicians' beliefs about the efficacy of medical treatment for hypercalcemia markedly influenced their attitudes. Clarifying evidence on the effect of hypercalcemia treatment on patients' symptoms and prognoses is strongly encouraged.
authors.affiliation: Tohoku University Hospital Palliative Care Center, Seiryo-cho 1-1, Aoba, Sendai, Miyagi, 980-8575, Japan, stetsu@med.tohoku.ac.jp.
authors.forename: Akira
authors.initials: A
authors.lastname: Shimada
authors.forename: Ichiro
authors.initials: I
authors.lastname: Mori
authors.forename: Isseki
authors.initials: I
authors.lastname: Maeda
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Watanabe
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Kikuchi
authors.forename: Hansheng
authors.initials: H
authors.lastname: Ding
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Morita
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D004164:Diphosphonates / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000628:therapy; D010146:Pain / Q000503:physiopathology; D010820:Physicians / Q000523:psychology; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D011788:Quality of Life; D012008:Recurrence; D011795:Surveys and Questionnaires; D019452:Terminally Ill
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates