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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 J Health Promot 2016;16(2):101-110.

Published online: 20 January 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 Zang2, , 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 7 January 2016       Accepted 10 May 2016

Copyright © 2016 The Korean Society of Health Promotion and Disease Prevention

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

References

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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)
Older aged Middle aged Paired t-test Pa
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.

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