J Korean Med Sci.  2020 Dec;35(47):e401. 10.3346/jkms.2020.35.e401.

The Attitudes of Physicians and the General Public toward Prognostic Disclosure of Different Serious Illnesses: a Korean Nationwide Study

Affiliations
  • 1Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
  • 2Department of Medicine, Yonsei University Graduate School, Seoul, Korea
  • 3Hospice & Palliative Care Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
  • 4Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
  • 5Division of Hematology and Medical Oncology, Department of Internal Medicine, Chonnam National University School of Medicine, Hwasun, Korea
  • 6Division of Hematology/Oncology, Jeonbuk National University Medical School, Jeonju, Korea
  • 7Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju, Korea
  • 8Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
  • 9Department of Hemato-oncology, Daegu Fatima Hospital, Daegu, Korea
  • 10Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
  • 11Division of Medical Oncology and Hematology, Department of Internal Medicine, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea
  • 12Division of Medical Oncology, Department of Internal Medicine, Korea University College of Medicine, Korea University Guro Hospital, Seoul, Korea
  • 13Department of Internal Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
  • 14Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
  • 15Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • 16Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Korea
  • 17Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea

Abstract

Background
Although international guidelines recommend palliative care approaches for many serious illnesses, the palliative needs of patients with serious illnesses other than cancer are often unmet, mainly due to insufficient prognosis-related discussion. We investigated physicians' and the general public's respective attitudes toward prognostic disclosure for several serious illnesses.
Methods
We conducted a cross-sectional survey of 928 physicians, sourced from 12 hospitals and the Korean Medical Association, and 1,005 members of the general public, sourced from all 17 administrative divisions in Korea.
Results
For most illnesses, most physicians (adjusted proportions – end-organ failure, 99.0%; incurable genetic or neurologic disease, 98.5%; acquired immune deficiency syndrome [AIDS], 98.4%; stroke or Parkinson's disease, 96.0%; and dementia, 89.6%) and members of the general public (end-organ failure, 92.0%; incurable genetic or neurologic disease, 92.5%; AIDS, 91.5%; stroke or Parkinson's disease, 92.1%; and dementia, 86.9%) wanted to be informed if they had a terminal prognosis. For physicians and the general public, the primary factor to consider when disclosing terminal status was “the patient's right to know his/her condition” (31.0%). Yet, the general public was less likely to prefer prognostic disclosure than physicians. Particularly, when their family members were patients, more than 10% of the general public did not want patients to be informed of their terminal prognosis. For the general public, the main reason for not disclosing prognosis was “psychological burden such as anxiety and depression” (35.8%), while for the physicians it was “disclosure would have no beneficial effect” (42.4%).
Conclusion
Most Physicians and the general public agreed that disclosure of a terminal prognosis respects patient autonomy for several serious illnesses. The low response rate of physicians might limit the generalizability of the results.

Keyword

End of Life Care; Communication; Chronic Conditions; HIV/AIDS; Neurological Conditions
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