Changes In Physicians' Attitudes Toward Telling The Cancer Patient

Our plain-English summary of Changes In Physicians' Attitudes Toward Telling The Cancer Patient, by D.H. Novack, R. Plumer, R.L. Smith, et al (1979).

The study

• Authors: D.H. Novack, R. Plumer, R.L. Smith, H. Ochitill, G.R. Morrow, J.M. Bennett
• Published: Journal Of The American Medical Association 241(9):897-900, March 2 (1979)
• Type of article: Journal article
• Our copy: from Johns-Manville's own medical library, J-M no. 001042. The article is still under copyright, so we describe it here rather than post it.

In plain English

This article is not about asbestos. It reported a 1977 questionnaire survey of physicians listed in the Strong Memorial Hospital directory (pathologists and psychiatrists excluded) about whether they told patients they had cancer. The questionnaire was nearly the same as one used in a 1961 survey by Oken, and the authors compared the two groups. Most 1977 respondents said their general policy was to tell the patient, in sharp contrast with the 1961 group, most of whom generally did not. In 1977, 24% cited medical school teaching as a source of their policy, compared with 7% in 1961, and 53% cited hospital training, compared with 35%. Personal elements were reported as involved by 92% of the 1977 group and 71% of the 1961 group. Of the 1977 group, 74% said their policy had not changed, and this group was significantly less likely than the 1961 group to expect future change. All 1977 respondents said patients have a right to know. The authors concluded that physicians still base policy on emotion-laden personal conviction rather than properly designed scientific studies.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Questionnaire survey of physicians, compared with an earlier (1961) survey by Oken using an almost identical questionnaire
• Who was studied: Physicians listed in the physician staff directory of Strong Memorial Hospital (Rochester, NY), with pathologists and psychiatrists excluded, surveyed in 1977. The number surveyed is printed as 499, but the scan is damaged here. The response count is unreadable. The 1977 sample had a mean age of 37 years and was 91% men; the 1961 sample had a mean age of 50 years and was 97% men.
• Main results:
  • Most 1977 respondents reported a general policy of telling the patient the diagnosis, in sharp contrast with the 1961 data, in which most generally did not tell. The exact percentages are unreadable in the scan.
  • Medical school teaching was cited as a source of policy by 24% of the 1977 sample vs 7% of the 1961 sample. Hospital training was cited by 53% vs 35%.
  • Personal elements were reported as involved in their policy by 71% of the 1961 survey and 92% of the 1977 survey.
  • 74% of the 1977 group said their policy had not changed in the past.
  • The 1977 respondents showed significantly less likelihood than the 1961 group of changing their policy in the future.
  • 100% of the 1977 respondents thought that the patient has the right to know.
  • 18% of the 1977 sample said they were less likely to tell a child.
  • No differences between specialties were found, except that pediatricians made exceptions to their usual policy of telling more often than other physicians.
• The authors' conclusion: The authors concluded that physicians are still basing their policies on emotion-laden personal conviction rather than on the results of properly designed scientific studies.
• Limitations the authors state:
  • In a partly unreadable passage, the authors appear to acknowledge that physicians who believed strongly in telling the patient may have been the ones who responded. They state that a significant change since Oken's study remained.
  • Oncology was slightly overrepresented in the sample, and surgery and obstetrics and gynecology were slightly underrepresented.

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