It is important to understand cancer patients' preferences for communication as it impacts on how unfavourable news should be delivered in such a way as not to demoralize the patients while at the same time maintain good doctor-patient relationships. However, few studies have been undertaken in the Asian countries. This study aims to determine the preferences of cancer patients regarding the disclosure of unfavourable news in an Asian population in Singapore. Two hundred cancer patients at the National Cancer Centre, Singapore, completed a Measure of Patients' Preferences (MPP) questionnaire on how they would like their physicians to tell them unfavourable news about their condition. The patients rated the content and context of the communication as well as the physicians' characteristics on a five-point Likert scale. Items that scored the highest mostly related to physicians' expertise and content of the interaction, while those relating to the supportive aspects scored the lowest. Gender was significantly associated with scores on the support subscale of the MPP such that women reported that the supportive elements were more important than the men did. No other demographic and medical characteristics were associated with patients' preferences. Exploratory factor analysis yielded two main factors, which accounted for 79.38% of the common variance. Patients' preferences in our local Asian population are fairly similar to those obtained from other studies conducted in the West, despite possible socio-cultural differences such as the use of euphemisms.

We investigated the non-response rates to the question "I am satisfied with my sex life" in the Functional Assessment of Cancer Therapy-General questionnaire in Chinese (n = 769), Malay (n = 41) and Indian (n = 33) patients in Singapore, a multi-ethnic society whose residents are said to have a conservative sexual attitude. Non-response rates to the question were 44%, 22% and 24% in the three groups respectively. The rates were much higher than that reported previously in a US study (7%) and used in the associated simulation study of the simple mean imputation method. We further examined the Chinese respondents in detail. The odds of non-response and the scores among the responders were associated with several demographic and clinical characteristics. Using the checklist proposed by Fayers et al. [Stat Med 1998; 17: 679-696] to assess the data patterns, we found that the application of the simple mean imputation is questionable. We employed an alternative (multiple) imputation procedure that took into account covariates that predicted the odds of non-response and the observed response scores. We compared the analytic results based on different approaches to handling missing values, and found that analysis based on the simple mean imputation gave results similar to that based on multiply imputed data even in this quite extreme example.