The General Practitioner and Information to Cancer Patients

Abstract

Information to cancer patients is a continuous process, and a considerable personal undertaking is usually needed. The general practitioner is in an unique position because of his contact with the cancer patient and his family during all stages of the diseaes. This gives him both opportunities and the responsibility for this information.The basis for cancer patient information can briefly be given in the "three c's": Communication, Coordination and Cooperation-communication both to patient and family and coordination and cooperation between the multitude of professionals, who often take care of the cancer patient right through his illness. Key words: geneml practice, patient infonnorion, cancer.M. Nylenna, Institute of General Practice, Fr. Stangsgate 11/13, 0264 Oslo 2, Norway.It has been said that knowledge is the antidote to fear, and probably no other disease is so closely related to fear as cancer. Anxiety accompanies most cancer patients, even those with an excellent prognosis (1). Patients who feel they are not being told enough are often "suffering from a feeling of insecurity" (2).Most of the studies of cancer patient information have been done in hospital since this setting is normally where the diagnosis is made and the prognosis discussed (3).Studies show that most cancer patients want to be informed of their disease (3-7). However, it has been observed that this wish declines with progressing disease (8). Over the last 10-20 years there has been a change in the attitudes of the doctors in this field (9). More cancer patients are now told both diagnosis, prognosis and treatment alternatives, and most physicians no longer protect their patients by not giving them information. There are perhaps many reasons for this change: improving therapy and better prognosis, a general increase in public awareness of cancer, less stigmatization of cancer, better consumer attitudes to the health professions and more consciousness about "patients' rights" (10).The general practitioner plays an important role in this information. Usually the general practitioner represents the patient's entry to the health care system, and for most patients he also is the symbol of continuity. The general practitioner will have the best knowledge of the patient's total situation. In addition he is often the only available source of information when questions arise. COMMUNICATIONCommunication is the keyword to any information. The information for cancer patients should ideally be based upon a planned, continuous process and should be careful, phased and individual. Planned information means that doctors, nurses and other health-workers involved should discuss and decide together what to say and how and when to tell.The cancer patient himself will often indicate when and what sort of information he wants, and a listening approach is recommended (2,8). Every question the patient asks should be honestly answered, but information should not be forced on him. It has been shown that good patient-communication may be rarer than one would thin...

Older Women With Breast Cancer: New Understandings Through Grounded Theory Research

“…Researchers have suggested that a cancer diagnosis should be relayed with compassion, concern, truthfulness, matter-of-factness and, sincerity, and continuing support should be offered in the same manner (Brewin, 1990;Nylenna, 1985;Peteet, Abrahms, Ross, & Stearn, 1991). Cancer, for these women, was associated with death, loss, anxiety, fear, and helplessness despite early staging of disease (Creagan, 1993;Eardley, 1988;Kriesel, 1987); however, issues in communication with physicians were safely raised only when the treatment was complete, problems had disappeared, and dependence on the oncology system was less necessary.…”