Patients do not live in an information vacuum

Abstract

We select the letters for these pages from the rapid responses posted on bmj.com favouring those received within five days of publication of the article to which they refer. Letters are thus an early selection of rapid responses on a particular topic. Readers should consult the website for the full list of responses and any authors' replies, which usually arrive after our selection. lp woods Candour on unfunded treatments Ignorance is a public health issue Marcus indicates the importance of candour in outlining the choices available to individuals. 1 However, there is also the effect on wider issues of public health and the availability of treatment options from which patients can choose. Unacceptable radiotherapy waiting times have been highlighted by the Royal College of Radiologists for over a decade. 2 They have now started to improve, but the last audit in September 2005 still showed that over half our patients wait longer than one month for curative treatment. What is probably not made clear to patients is the impact that this can have on their prognosis. A systematic review has shown that for breast cancer a wait of longer than eight weeks carries a 60% increase in the risk of local recurrence over five years. 3 For postoperative radiotherapy of head and neck cancer, a delay of six weeks increases the risk of local recurrence 2.6-fold. 3 Worse than this, delay may render patients untreatable. An audit of waiting times in lung cancer patients showed that 20% progressed so that they were unsuitable for radical radiotherapy while on a waiting list. 4 An update in 2007 showed no change. 5 These are serious risks to patients. Our failure to communicate them or to bring them into the public arena has contributed to the current lamentable state of our radiotherapy services. The report of the National Radiotherapy Advisory Group, which is currently with ministers, proposes a plan to tackle these issues.

An Egalitarian Perspective on Information Sharing: The Example of Health Care Priorities

“…Furthermore, patients are exposed to, and actively have to navigate between, various sources of information. Consequently, they may themselves find out that treatment options are being withheld without knowing the reason for it, and that could, in turn, harm the physician-patient relationship [ 36 ]. This also points to a different reason why a respectful approach towards equals calls for transparency in this context.…”