How Doctors Deliver the News: It's Cancer

LA Times

Anyone who has undergone a biopsy or other test to detect cancer knows the agony of waiting for the test results. Doctors face the dilemma of how to divulge the bad news to their patients. Call the minute you receive the results and let the patient know? Schedule a face-to-face office visit and explain the findings there?

A new study suggests that doctors should usually disclose a cancer diagnosis in a personal setting, taking plenty of time to discuss what the diagnosis means and explain treatment options. The study involved a questionnaire given to 437 patients who received a cancer diagnosis. The researchers, From the National Cancer Institute and Columbia University, found that 54% of patients were told their diagnosis in person in the doctor's office while 18% got the news by phone and 28% while in the hospital.

Perhaps more surprising, 45% of the patients reported discussions of 10 minutes or less. Options for Indianapolis cancer treatment were not discussed in 31% of the conversations. In 39% of the cases, the patient had no other person -- such as spouse, sibling or child -- present when they received the news.

When asked how satisfied they were with the way the cancer diagnosis was delivered, the average score on a scale from 0 to 100 (the most satisfied) was 73.5. Having another person present when the diagnosis was given did not seem to matter to most patients. However, where and how the news was delivered did matter. Patients who heard their diagnosis in person had much higher satisfaction scores than those who received the diagnosis over the phone. Conversations that took place in the doctor's office were rated higher by patients than talks that took place in an impersonal setting, such as a recovery room or Dearborn radiology suite. Only a small percentage of patients reported very poor communication and lack of trust in their doctor. There were a few horror stories. "...my doctor at the time called me on Valentine's day to say I had a lesion in my chest.... He left this message on my home answering machine."

Some situations may warrant using the telephone to divulge a cancer diagnosis, the authors wrote, such as when the patient already knows that cancer is suspected and has been waiting for several days to learn the test results. But, in general, a cancer diagnosis should be made in-person in a hospital room or doctor's office with sufficient time available to discuss prognosis and treatment. "...having more than 20% of patients told their diagnosis in an impersonal manner suggests too many physicians are either unaware of or not practicing good communication skills in such bad news circumstances," the authors wrote. The study was released Tuesday in the Journal of Clinical Oncology.