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The Cancer Community Discovers Family Medicine, Sort Of

October 28, 2012

A study about quality of life for patients with terminal cancer was reported by Medscape News. I won’t repeat the whole article here, but let me let you in on a few of their insights.

Said the director of a Center of the Dana-Farber Cancer Institute, “Physicians who claim that there is little that they have to offer their dying patients should realize that their willingness to be present and not abandon their patients matters a tremendous amount to the quality of life of patients.” She went on to say, “In the end, what matters most to patients is that their psychosocial needs are met. When cure is not an option, care should imply psychosocial and spiritual care and concern.”

And further, “… [P]atients who felt a strong ‘therapeutic alliance’ with their clinician had a better quality of life at the end. Measures of therapeutic alliance looked at patient belief that they were being treated with respect and as a whole person by their clinician, patient trust in and respect for their clinician, and patient comfort in asking their clinician about their care ….”

Two doctors from the NIH commented, “… clinicians, on average, had poor skills when it came to handling emotions and only moderate skills when it came to discussing end-of-life issues ( J Palliat Med. 2010;13:949-956). “Failure of these channels of communication and undefined, incompletely developed partnerships between patient and physician or other care providers likely frequently result in provision of care that ultimately negatively affects the quality of the end of life.”

Trust, relationships, therapeutic alliance, respect, communication, non-abandonment, presence, comfort — I’m so thrilled that the cancer community seems to be discovering that these issues are important. Too bad for all cancer patients that the onc-ologists and the payers don’t know that family physicians figured this out 40 years ago.

I’ll believe “they” get it when I’m paid as much as a round of chemotherapy to just sit with one of my long-term patients with terminal cancer, hold their hand, and be still, just be there in their presence.

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