Doctors' Ageism towards the Elderly Cancer Patients: Focusing on Disclosure of Cancer Diagnosis and Explanation on Treatment

Yeonok Lim; Dae Young Zang; Dae Ro Choi; Seok Yun Kang; Young Suk Park; Hyunsook Yoon; Hyunjoo Lee; Yojin Kim; Ilsung Nam; Kyoungwon Choi

doi:10.15384/kjhp.2016.16.2.101

Korean J Health Promot > Volume 16(2); 2016 > Article

Lim, Zang, Choi, Kang, Park, Yoon, Lee, Kim, Nam, and Choi: Doctors' Ageism towards the Elderly Cancer Patients: Focusing on Disclosure of Cancer Diagnosis and Explanation on Treatment

Original Article

Korean Journal of Health Promotion 2016;16(2):101-110.

Published online: January 20, 2016

DOI: https://doi.org/10.15384/kjhp.2016.16.2.101

Doctors' Ageism towards the Elderly Cancer Patients: Focusing on Disclosure of Cancer Diagnosis and Explanation on Treatment

Yeonok Lim¹, Dae Young Zang^2,, Dae Ro Choi³, Seok Yun Kang⁴, Young Suk Park⁵, Hyunsook Yoon⁶, Hyunjoo Lee⁷, Yojin Kim⁶, Ilsung Nam⁸, Kyoungwon Choi⁹

¹Institute of Aging, Hallym University, Chuncheon, Korea

²Division of Hematology-Oncology, Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Korea

³Division of Hematology-Oncology, Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, Chuncheon, Korea

⁴Department of Hematology-Oncology, Aju University Hospital, Ajou University School of Medicine, Suwon, Korea

⁵Divisions of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

⁶Department of Social Welfare, Hallym University, Chuncheon, Korea

⁷Department of Social Welfare, Hallym Polytechnic University, Chuncheon, Korea

⁸Department of Social Welfare, Sungkonghoe University, Seoul, Korea

⁹Department of Social Welfare, Graduate School of Hallym University, Chuncheon, Korea

Corresponding author: Dae Young Zang, MD Division of Hematology-Oncology, Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang 14068, Korea
Tel: +82-31-380-1500, Fax: +82-31-380-4118 E-mail: fhdzang@hallym.ac.kr

Received January 07, 2016 Accepted May 10, 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background

This research is an exploratory study that is based on previous studies focusing on relationship between the doctors and the elderly cancer patients; moreover, the research focuses on the doctors' negative attitudes and discriminative behaviors towards the elderly cancer patients so that we may be able to suggest the ways to decrease the ageism.

Methods

Qualitative method and quantitative method were applied sequently. In this research, we practiced in-depth interviews with 8 doctors and then the surveys with 274 doctors. The in-depth interview questions were categorized depending on meaningful testimonies and the survey data were analyzed in the descriptive statistic analysis and paired t-test using PASW statistics 18.

Results

Through the in-depth interviews, the following is observed: the doctors rarely notify the elderly cancer patients directly; the family members of patients avoids the doctors to do so; and the doctors even show different attitudes or discriminatory actions to the elderly. Based on the in-depth interview results, the questions on notifying methods of the diagnosis and how to explain for treatment were developed and performed as a survey. Through the survey, only 8.4% of the doctors reported they directly notify the elderly cancer patient; moreover, they also reported they provide less information on treatment, side-effects, prognosis, and medical cost to the elderly than the middle-aged.

Conclusions

This research not only discovered the presence of discrimination towards the elderly cancer patients but also suggested the causes of it. In order to resolve the phenomenon, doctors must consider individualized difference and variability of physiological function and should be aware of the psychological change after the cancer diagnosis to better communicate with them. Additionally, the social family culture which overprotects the elderly must be changed.

Keywords: Ageism, Cancer, Elderly, Diagnosis

Table 1.

Doctors' experiences on disclosure of cancer diagnosis and treatment explanation to elderly cancer patients

Category	Sub-category
Directly informing the younger adults	• The doctor informs the adults directly
who aware in right of self determination	• The younger adults aware in the right of self determination
	• The doctor informs the truths the younger adult in oder to plan the future
Informing the elder who has authority	• The elder has authority and the awareness in self determination
Asking the family to accompany with the	• The elder has hearing loss
elder due to hardship in conversation	• The elder has deterioration in comprehension
with the elder who comes alone	• The elder has deterioration in memorization
	• The elder shows dementia or delirium
	• The doctor watches the countenance of the elder whether she/he is informed about the cancer diagnosis
	• The doctor calls the family to comprehend the family's intention
The family's request to keep the cancer	• The family is not willing to inform the elder
diagnosis as a secret	• The family asks to secure the cancer diagnosis to their elders.
	• The family worries the elder's renouncement in treatment
	• The family worries the loss of desire in living of the elder
	• The family members worry about the physical/financial burden in the process of treatment
Following the demand of the family	• The doctor follows the demand of the family in a discontent matter
	• The doctor informs the cancer diagnosis due to the family's insistence, who knows well about the character of the elder
Persuading the family to inform the elder	• The doctor persuades the family to accompany in the process
about the cancer diagnosis	• The doctor persuades the family to talk to the patient himself or herself
	• The elder needs to know in order to reorganize the rest of the time in his or her life
	• In order to deal with the side effect, the elder needs to know about the disease
	• The patient has the right to know about his or her condition
Informing the elder about the cancer di-	• It is hard for the doctor to inform the elder that she/he is diagnosed of cancer
agnosis in a euphemistic way	• The doctor expresses in a euphemistic matter
	• The doctor makes the patient understand in his or her level of consciousness
	• The doctor explains in a hopeful matter than the true condition
Explaining differently in different ages	• The doctor explains thoroughly about the schedule and the side-effect of the treatment to younger
	adults
	• The doctor informs more objectively and accurately about the prognosis and the side-effect of the treatment to an younger patient
	• The doctor denies to explain truth or tells in a hopeful matter to the elder
	• The doctor avoids to conversation about the financial matter

Table 2.

Doctor's characteristics

Characteristics		doctor (n = 274)
Age, y		41.11±8.46, 29–67
Gender	Male	194 (70.8)
	Female	80 (29.2)
Religion	Buddhism	28 (10.3)
	Catholic	67 (24.6)
	Protestant	82 (30.1)
	Others	2 (0.8)
	None	93 (34.2)
Proportion of cancer patients among total patients	Less than 25%	39 (14.2)
	25–50%	33 (12.0)
	50–75%	47 (17.2)
	75% and more	155 (56.6)
Proportion of elder among cancer patients	Less than 25%	26 (9.5)
	25–50%	57 (20.9)
	50–75%	137 (50.2)
	75% and more	53 (19.4)
Education experience of geriatrics	No	97 (35.4)
	Yes	177 (64.6)
Career experience	Specialist career	9.97±08.54, 0–36

Table 3.

How to inform cancer diagnosis at first (n = 274)

Characteristics	n
I talk to the older person directly at first.	23 (8.4)
I talk to spouse or adult children at first, and I make them talk to elder.	51 (18.6)
I talk to spouse or adult children at first, and then I talk to elder.	195 (71.2)
No answer.	5 (1.8)
Total	206 (100.0)

Values are presented as n (%).

Table 4.

Comparison between the treatment explanations to older aged and middle aged in doctors

Dimension	Doctor (n = 274)
Dimension	Older aged	Middle aged	Paired t_-test	P^a
Treatment method and process	3.87 (0.77)	4.47 (0.60)	–13.14	<0.001
ide effect of treatment	3.64 (0.81)	4.34 (0.64)	–14.297	<0.001
Prognosis	3.32 (0.87)	4.22 (0.69)	–17.128	<0.001
Medical fee	2.64 (0.88)	3.42 (1.03)	–13.558	<0.001

Values are presented as mean±SE. When comparing group differences, paired t-test was used for the continuous variable. Calculated by paired t-test.

References

1. Jung KW, Won YJ, Kong HJ, Oh CM, Cho H, Lee DH, et al. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2012. Cancer Res Treat 2015;47(2):127-41.

2. Wedding U, Pientca L, Höffken K. Quality-of-life in elderly patients with cancer: a short review. Eur J Cancer 2007;43(15):2203-10.

3. NHS Scotland. Adding life to years: report of the Expert Group on Healthcare of Older People. Edinburgh: Scottish Executive; 2001. p. 33-4. 44–55..

4. Lavelle K, Todd C, Moran A, Howell A, Bundred N, Campbell M. Non-standard management of breast cancer increases with age in the UK: a population based cohort of women > or=65 years. Br J Cancer 2007;96(8):1197-203.

5. Butler RN. Ageism: another form of bigotry. Gerontologist 1969;9(4):243-6.

6. Butler R. Ageism. The encyclopedia of aging. New York: Springer; 1987.

7. Chun HR, Kim IH. Ageism and health: focus on socioeconomic factors. J Korean Gerontological Soc 2013;33(3):601-5.

8. Palmore EB. Ageism: negative and positive. New York: Springer Publishing Company; 1999.

9. Kuypers JA, Bengtson VL. Social breakdown and competence. A model of normal aging. Hum Dev 1973;16(3):181-201.

10. Williams PW. Age discrimination in the delivery of health care services to our elders. Marquette Elder's Advisor 2009;11(1):3-45.

11. Lim YS, Kim JS, Kim KS. Nurses' knowledge and attitudes toward the elderly. J Korea Gerontological Soc 2002;22(1):31-46.

12. Kim C, Kwon Y. The relationship with the knowledge, attitude and nursing practice of the nurses: towards the elderly in geriatric hospital. Keimyung J Nurs Sci 2009;13(1):39-50.

13. Park HS, So SR, Kim SH, Relationships among knowledge, attitude, and use of negative control maintenance techniques toward older adults among nurses working in geriatric hospitals. Korean J Acad Adult Nurs 2007;19(4):614-23.

14. Sim SH, Kim JS. A study on knowledge of and attitude to the elderly among some dental hygienist. J Dent Hyg Sci 2010;10(2):71-7.

15. Jung JY, Yoon SY. Elder care related knowledge, attitudes, nursing practice and awareness of elder abuse in geriatric hospital health personnels. J Korean Gerontological Nurs 2012;14(3):233-41.

16. Penson RT, Daniels KJ, Lynch TJ Jr. Too old to care? Oncologist 2004;9(3):343-52.

17. The Anti-Ageism Taskforce at The International Longevity Center. Ageism in America. New York: ILC-USA; 2006. p. 69-72.

18. Kim W. An exploratory study on ageism experienced by the elderly and its related factors. J Korean Gerontological Soc 2003;23(2):21-35.

19. Padgett DK. Qualitative Methods in Social Work Research. Seoul: Nannam Publishing House; 2001. p. 237-49.

20. Mystakidou K, Parpa E, Tsilika E, Katsouda E, Vlahos L. Cancer information disclosure in different cultural contexts. Support Care Cancer 2004;12(3):147-54.

21. Billings J. Staff perceptions of ageist practice in the clinical setting: practice in the clinical setting: practice development project, Canterbury: University of Kent. Centre for Health Services Studies. 2003;13-21.

22. Kim HS. Aspects of shared decision making of the medical treatments for older cancer patients [dissertation]. Seoul: Chung-Ang University; 2009. Korean..

23. Lee SM, Kim SY, Lee HS. The process of medical decision-making for cancer patients. Korean J Med Ethics 2009;12(1):1-14.

24. Healthchosun. Noticing the patient right after the diagnose of the cancer makes the satisfaction of the treatment and the understanding of the process. Reston: Healthchosun; 2012. [Accessed October 20, 2015].. http://health.chosun.com/site/data/html_dir/2012/04/11/2012041100003.html.

25. Lee HJ, Lim YO, Yoon HS, Kim YJ, Choi KW. Post-surgery chemotherapy treatment experiences of older male patients with stomach cancer. J Korean Gerontological Soc 2014;34(3):495-521.

26. JoogAng Ilbo. Seosomoon forum: the patient in the last stage of cancer has the right to know. Reston: JoogAng Ilbo, 2013. [Accessed October 20; 2015. ].. http://news.joins.com/article/11753911.

27. Lee SH, Jung SE. Elderly's Experience on Discrimination. Soc Res 2010;19(1):45-68.