A survey of gynecologic oncologists regarding the end-of-life discussion: a pilot study

Objectives: To identify the practices and attitudes of gynecologic oncologists regarding the end-of-life discussion.

Methods: A pilot survey was sent to 1105 members of the Society of Gynecologic Oncologists (SGO). The survey consisted of 20 questions and was sent via the website Survey Monkey.

Results: Response rate was 12.8%. Sixty percent of respondents were male, most ranged between 30 and 60 years of age and more than half performed 5-10 major surgeries per week. More than half of respondents (53.9%) deferred the End of Life discussion until the patient had sustained a major change in functional and/or medical status. Thirty percent initiated it at the first recurrence or progression of disease. Forty three percent of respondents characterized the discussion as an on-going process. Patients' age, social support, health insurance, and co-morbidities had no influence on the discussion, and neither did the tumor's site of origin or grade. More respondents initiated the discussion in advanced stage cancer (57%) and after salvage chemotherapy institution (54%). Forty four percent of respondents reported that "understanding and acceptance" was the initial response by patient when counseled about withdrawal of care. This increased to 86% when the issue was revisited. Confusion or reluctance to discuss the subject were initially reported to be 12% and 19%, respectively, but decreased to 2% and 3%, respectively, when withdrawal of care was subsequently addressed with the patient.

Conclusions: This pilot survey sheds a light on attitudes and practices about the end-of-life discussion that deserve to be further studied.