Direct communication, the unquestionable ideal? Oncologists' accounts of communication of bleak prognoses

Objective: To explore the factors that influence the clinical practice of oncologists concerning disclosure of prognostic information. Methods: Focus group interviews with oncologists in three Norwegian university hospitals. Interview guide consisting of three patient cases where challenging aspects of prognostic information delivery were presented to the participants. Each group consisted of six participants, all groups with a mix of men and women, and ranging from very experienced consultants to relatively inexperienced residents in oncology. Transcribed interviews were qualitatively analyzed through categorization and condensation. Results: The importance of openness when dealing with prognostic information towards the end of life was strongly advocated by all participants. However, there was a reluctance to give tangible information regarding survival, and a feeling that this part of clinical practice was a challenge. Skills in how to communicate negative prognostic information were attained primarily by observing colleagues, but also from personal experience. Existing guidelines for communication were not perceived as useful. Conclusion: Primarily focusing on open communication regarding bleak prospects of life expectancy entails a risk of overrunning the information needs of individual patients. Oncologists still see communication skills primarily as personal, and are at risk of not exploring and responding to the individual patient's wish for information. Copyright (C) 2010 John Wiley & Sons, Ltd.