title: A National Survey to Systematically Identify Factors Associated With Oncologists' Attitudes Toward End-of-Life Discussions: What Determines Timing of End-of-Life Discussions?
abstract: BACKGROUND
  End-of-life discussions (EOLds) occur infrequently until cancer patients become terminally ill.
  
  
  METHODS
  To identify factors associated with the timing of EOLds, we conducted a nationwide survey of 864 medical oncologists. We surveyed the timing of EOLds held with advanced cancer patients regarding prognosis, hospice, site of death, and do-not-resuscitate (DNR) status; and we surveyed physicians' experience of EOLds, perceptions of a good death, and beliefs regarding these issues. Multivariate analyses identified determinants of early discussions.
  
  
  RESULTS
  Among 490 physicians (response rate: 57%), 165 (34%), 65 (14%), 47 (9.8%), and 20 (4.2%) would discuss prognosis, hospice, site of death, and DNR status, respectively, "now" (i.e., at diagnosis) with a hypothetical patient with newly diagnosed metastatic cancer. In multivariate analyses, determinants of discussing prognosis "now" included the physician perceiving greater importance of autonomy in experiencing a good death (odds ratio [OR]: 1.34; p = .014), less perceived difficulty estimating the prognosis (OR: 0.77; p = .012), and being a hematologist (OR: 1.68; p = .016). Determinants of discussing hospice "now" included the physician perceiving greater importance of life completion in experiencing a good death (OR: 1.58; p = .018), less discomfort talking about death (OR: 0.67; p = .002), and no responsibility as treating physician at end of life (OR: 1.94; p = .031). Determinants of discussing site of death "now" included the physician perceiving greater importance of life completion in experiencing a good death (OR: 1.83; p = .008) and less discomfort talking about death (OR: 0.74; p = .034). The determinant of discussing DNR status "now" was less discomfort talking about death (OR: 0.49; p = .003).
  
  
  CONCLUSIONS
  Reflection by oncologists on their own values regarding a good death, knowledge about validated prognostic measures, and learning skills to manage discomfort talking about death is helpful for oncologists to perform appropriate EOLds.
  
  
  CONCLUSIONS
  Oncologists' own perceptions about what is important for a "good death," perceived difficulty in estimating the prognosis, and discomfort in talking about death influence their attitudes toward end-of-life discussions. Reflection on their own values regarding a good death, knowledge about validated prognostic measures, and learning skills to manage discomfort talking about death are important for improving oncologists' skills in facilitating end-of-life discussions.
authors.affiliation: Department of Palliative Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Mori
authors.affiliation: Breast and Medical Oncology Division.
authors.forename: Chikako
authors.initials: C
authors.lastname: Shimizu
authors.affiliation: Psycho-Oncology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Japan asogawa@east.ncc.go.jp.
authors.forename: Asao
authors.initials: A
authors.lastname: Ogawa
authors.affiliation: Hepatobiliary and Pancreatic Oncology Division.
authors.forename: Takuji
authors.initials: T
authors.lastname: Okusaka
authors.affiliation: Center for Cancer Control and Information Services, National Cancer Center Hospital, Chuo-ku, Japan.
authors.forename: Saran
authors.initials: S
authors.lastname: Yoshida
authors.affiliation: Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Morita
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000941:ethics* / Q000639:trends; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000523:psychology; D010817:Physician-Patient Relations; D010820:Physicians / Q000941:ethics* / Q000523:psychology; D019452:Terminally Ill / Q000523:psychology
keywords: Attitude; Do-not-resuscitate; End-of-life discussion; Hospice; Oncologist