Association between oncologists' death anxiety and their end-of-life communication with advanced cancer patients

TY - JOUR

T1 - Association between oncologists' death anxiety and their end-of-life communication with advanced cancer patients

AU - Harnischfeger, Nele

AU - Rath, Hilke M

AU - Alt-Epping, Bernd

AU - Brand, Hannah

AU - Haller, Karl

AU - Letsch, Anne

AU - Rieder, Nicola

AU - Thuss-Patience, Peter

AU - Bokemeyer, Carsten

AU - Oechsle, Karin

AU - Bergelt, Corinna

N1 - © 2023 The Authors. Psycho-Oncology published by John Wiley & Sons Ltd.

PY - 2023/6

Y1 - 2023/6

N2 - OBJECTIVE: Early and open communication of palliative care (PC) and end-of-life (EoL)-related issues in advanced cancer care is not only recommended by guidelines, but also preferred by the majority of patients. However, oncologists tend to avoid timely addressing these issues. We investigated the role of oncologists' personal death anxiety in the rare occurrence of PC/EoL conversations.METHODS: We conducted a multicenter cross-sectional study assessing oncologists' strengths and difficulties in self-reported and externally rated PC/EoL communication skills as well as their association with death anxiety. Death anxiety was assessed via the Thanatophobia-Scale. PC/EoL communication skills were assessed via validated questionnaires and study-specific items plus an external rating of videotaped medical consultation with simulated patients. A general linear model was conducted to analyze associations.RESULTS: One hundred fifty-three oncologists participated (age: M(SD) = 32.9 years (6.9), 59.5% female). Both from the external and from their own perspective, oncologists had difficulties in addressing PC and the EoL. They avoided those aspects more than other topics in consultations with advanced cancer patients. Death anxiety was associated with more avoidant self-reported communication strategies, lower self-efficacy, less confidence in discussing the EoL and less confidence in discussing patients' goals and wishes, but was not associated with externally rated PC/EoL communication.CONCLUSIONS: Oncologists have experienced and externally observable difficulties in addressing PC and the EoL. Oncologists with higher death anxiety subjectively experience more difficulties. Group supervision and consultation offers might be means to empower oncologists, increase awareness of personal fears and enhance confidence and self-efficacy. This might facilitate earlier PC/EoL communication.

AB - OBJECTIVE: Early and open communication of palliative care (PC) and end-of-life (EoL)-related issues in advanced cancer care is not only recommended by guidelines, but also preferred by the majority of patients. However, oncologists tend to avoid timely addressing these issues. We investigated the role of oncologists' personal death anxiety in the rare occurrence of PC/EoL conversations.METHODS: We conducted a multicenter cross-sectional study assessing oncologists' strengths and difficulties in self-reported and externally rated PC/EoL communication skills as well as their association with death anxiety. Death anxiety was assessed via the Thanatophobia-Scale. PC/EoL communication skills were assessed via validated questionnaires and study-specific items plus an external rating of videotaped medical consultation with simulated patients. A general linear model was conducted to analyze associations.RESULTS: One hundred fifty-three oncologists participated (age: M(SD) = 32.9 years (6.9), 59.5% female). Both from the external and from their own perspective, oncologists had difficulties in addressing PC and the EoL. They avoided those aspects more than other topics in consultations with advanced cancer patients. Death anxiety was associated with more avoidant self-reported communication strategies, lower self-efficacy, less confidence in discussing the EoL and less confidence in discussing patients' goals and wishes, but was not associated with externally rated PC/EoL communication.CONCLUSIONS: Oncologists have experienced and externally observable difficulties in addressing PC and the EoL. Oncologists with higher death anxiety subjectively experience more difficulties. Group supervision and consultation offers might be means to empower oncologists, increase awareness of personal fears and enhance confidence and self-efficacy. This might facilitate earlier PC/EoL communication.

U2 - 10.1002/pon.6132

DO - 10.1002/pon.6132

M3 - SCORING: Journal article

C2 - 37057315

VL - 32

SP - 923

EP - 932

JO - PSYCHO-ONCOLOGY

JF - PSYCHO-ONCOLOGY

SN - 1057-9249

IS - 6

ER -