"Unless you're doing an assessment of conflict, which oncologists do not do, I'm not surprised that they wouldn't perceive it," said Betty Kramer, who studies aging and family caregiving at the University of Wisconsin-Madison School of Social Work but wasn't involved in this research.

Primary caregivers are those people, usually a spouse or adult child, who take on responsibilities such as getting patients to appointments, following up on at-home care, providing comfort and meeting basic needs.

Laura Siminoff, from the Virginia Commonwealth University School of Medicine in Richmond, said she's seen there's often a disconnect between caregivers and patients about their goals and desires for cancer treatment.

"We then asked ourselves, are oncologists seeing what is happening between patient and family or is this hidden from them?" she said.

To try to answer that question, Siminoff and her colleagues interviewed 134 advanced lung cancer patients living in the Midwest, their oncologists and their primary caregivers.

The patients and family members were asked separately how often they disagreed on decisions about treatment -- such as whether or not to get extra tests and options for hospice care. Researchers surveyed the doctors on how often they perceived differences of opinion between patients and caregivers.

About 71 percent of the time both the patient and caregiver said there was no conflict between them, and 11 percent of the pairs agreed there were some problems.

Most of the time, doctors correctly reported there were no conflicts between patients and caregivers.

However, in the 17 cases when a caregiver alone reported some type of conflict, the oncologist picked up on it only five times.

Similarly, of the seven cases when only the patient reported conflict with a family caregiver, the oncologist recognized it just two times.

And in the 15 instances when both the patient and caregiver reported there had been conflict, the oncologist again agreed twice.

"This is not something that oncologists regularly explore with patients," said Siminoff.

Patients might not feel comfortable bringing up conflict during appointments when family members are present, or they might not want to bother their doctors with what they see as "trivial" issues, she told Reuters Health in an email.

The study did not explore whether patient-caregiver conflict -- and doctors' awareness of it -- had any impact on patients' health, but Kramer said disagreements can hinder treatment.

"If there's a conflict, treatment can't be provided promptly because you're trying to work through all these difficulties," she told Reuters Health.

Previous research has suggested conflict between patients and their caregivers also results in greater emotional stress, Siminoff added.

"The physician needs to be aware of these issues in order to intervene as needed," she said.

Dr. Anthony Back, an oncologist at the Seattle Cancer Care Alliance, agreed.

"In my practice (lack of awareness) is a cause of a lot of dissatisfaction," he said. "A lot of second-opinion patients I see come to me because they feel their doctor doesn't get them."

Back told Reuters Health that oncologists should try to pick up on cues suggesting there's some disagreement, and call in social workers or therapists to help resolve it.

"Sometimes those things are beyond the purview of the oncologist," said Back, who didn't participate in the research. "But when (patients and caregivers) have some major issues, they need to figure it out and we have other resources for them."

SOURCE: bit.ly/GXSAE8 Lung Cancer, online March 8, 2012.

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