Disclosing a Diagnosis of Cancer: Where and How Does It Occur?

Abstract

A B S T R A C T PurposeWhile disclosing a cancer diagnosis to a patient is common practice, how it is disclosed and the impact it has on the patient are poorly understood. We examined how cancer diagnoses were first given to patients and the impact of different aspects of disclosure on patient satisfaction. Patients and MethodsWe provided a self-administered questionnaire to a total of 460 oncology patients of the National Cancer Institute (NCI) being treated at the National Institutes of Health (NIH) Clinical Center in Bethesda, MD. ResultsOf the 437 patients who completed the survey, 54% were told their diagnosis in-person in the physician's office, 18% by phone, and 28% in the hospital. Forty-four percent of patients reported discussions of 10 minutes or fewer, 53% reported discussions lasting longer than 10 minutes, and 5% could not remember. Treatment options were not discussed for 31% of those who could clearly remember. Higher mean satisfaction scores were associated with diagnoses revealed in person rather than over the phone (68.2 Ϯ 1.6 v 47.2 Ϯ 3.7), diagnoses revealed in a personal setting rather than an impersonal setting (68.9 Ϯ 1.6 v 55.7 Ϯ 2.8), discussions lasting longer than 10 minutes rather than fewer than 10 minutes (73.5 Ϯ 1.9 v 54.1 Ϯ 2.4), and inclusion of treatment options rather than exclusion (72.0 Ϯ 1.9 v 50.7 Ϯ 3.2; P Ͻ .001 for each aspect). ConclusionPhysicians should disclose a cancer diagnosis in a personal setting, discussing the diagnosis and treatment options for a substantial period of time whenever possible.

Psychosocial adjustment to a prostate cancer diagnosis in a cohort of radical prostatectomy patients in Quebec, Canada

“…While patients may have perceived this differently from how the diagnosis was actually delivered, a previous study reported that patients generally remember well how bad news was delivered . Other recent studies also observed that it remains common to deliver a cancer diagnosis by telephone: 18% of patients treated at the National Cancer Institute, and 25% to 50% of breast cancer patients in the United States received their diagnosis by telephone . However, patients prefer that their diagnosis is delivered during a personal conversation with the physician, during which the physician takes the time to discuss the condition and its consequences .…”

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“…There are several publications on the topic of discussing cancer with the patient, such as that by Figg et al Others can be found by searching “physician” and “telling of bad news” or “disclosing a diagnosis of cancer.” This is also a moment that can be very badly handled by an inexperienced physician. If one is new to USGFNA, my advice would be to talk to a senior physician with experience in this area, whether that is another USGFNA pathologist, surgeon, or oncologist.…”

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