Kaiser Permanente Hawaii, Honolulu, HI, USA.
Internal Medicine Department, University of Hawaii, Honolulu, HI, USA.
J Cancer Educ. 2020 Oct;35(5):983-987. doi: 10.1007/s13187-019-01552-z.
Cancer is the second leading cause of death in the USA. Many internal medicine physicians feel uncomfortable having to prognosticate; however, oncology patients often ask this of them. The inability to provide an accurate prognosis could lead a patient to make a treatment decision incongruent with their true wishes. We conducted this study to assess resident and attending physicians' knowledge of cancer prognosis and to establish the source of residents' knowledge. We conducted a prospective, cross-sectional study to assess internal medicine resident and attending physician knowledge of median survival for seven different oncologic case scenarios. Correct answers were defined by results of randomized, phase III trials. Residents were asked to identify the source(s) of information that most significantly influenced their choices. All residents and attending physicians affiliated with the University of Hawaii were invited to participate. A total of 67 of 85 surveys (78.8%) were completed, representing 41 residents and 26 attending physicians. Overall, the respondents correctly estimated median survival 42.6% of the time. The respondents underestimated more often than overestimated median survival (46.3% vs. 14.9%, p = 0.0001). Seventy-three percent of residents cited inpatient experience as influencing their oncologic knowledge. Internal medicine residents and attending physicians correctly estimate median survival of cancer patients less than 50% of the time and often underestimate survival. Inpatient rotations, where residents care for the oncologic patients experiencing significant complications of their cancer and treatment, may be giving them an unbalanced perspective on cancer prognosis.
癌症是美国的第二大致死原因。许多内科医生觉得不得不进行预后预测，但肿瘤患者经常向他们提出这个要求。无法提供准确的预后可能会导致患者做出与他们真实意愿不符的治疗决策。我们进行这项研究是为了评估住院医师和主治医生对癌症预后的了解程度，并确定住院医师知识的来源。我们进行了一项前瞻性、横断面研究，以评估七种不同肿瘤病例场景中内科住院医师和主治医生对中位生存期的知识。正确答案由随机、III 期试验的结果定义。要求住院医师确定对其选择影响最大的信息来源。邀请了所有与夏威夷大学有关的住院医师和主治医生参加。共完成了 85 份调查中的 67 份（78.8%），代表 41 名住院医师和 26 名主治医生。总体而言，受访者正确估计中位生存期的时间为 42.6%。受访者低估中位生存期的次数多于高估的次数（46.3%比 14.9%，p=0.0001）。73%的住院医师将住院经验作为影响他们肿瘤学知识的因素。内科住院医师和主治医生正确估计癌症患者中位生存期的时间不到 50%，并且经常低估生存期。住院医师在住院期间照顾经历癌症及其治疗严重并发症的肿瘤患者，可能会使他们对癌症预后产生不平衡的看法。
