To understand patients' preferences regarding the disclosure of bad news is important in the clinical oncology setting. The aim of this study was to clarify descriptively the preferences of cancer patients. Five hundred and twenty-nine Japanese cancer outpatients were surveyed regarding their preferences regarding the disclosure of bad news, and several psychosocial and medical demographic variables were analyzed. In a descriptive analysis, more than 90% of the patients strongly preferred to discuss their current medical condition and treatment options with their physician and to have their physicians take the feelings of their family into consideration as well. While half of the patients preferred to receive information regarding their life expectancy, 30% preferred not to receive it. Multiple regression analyses indicated the preferences showing interindividual variations were associated with the level of education and the mental adjustment to cancer scores. A factor analysis revealed four preferences factors: method of disclosure of the bad news, provision of emotional support, provision of additional information, and setting. These four factors had good internal consistency reliability (Cronbach's alpha = 0.93-0.77). Providing emotional support, including the desire for the physician to show consideration for the patient's family, and understanding an individual's communication preferences may be useful for promoting patient-physician communication.

Screening cancer patients for adjustment disorders and major depression is important, because both are prevalent and often underrecognized. The purpose of this study was to validate the Distress and Impact Thermometer, a 2-item questionnaire, which we newly developed as a brief screening tool for detection of adjustment disorders and/or major depression. Two hundred ninety-five cancer patients completed the Distress and Impact Thermometer and the Hospital Anxiety and Depression Scale (HADS), and were examined by psychiatrists based on DSM-IV criteria. Using cutoff points for detection of adjustment disorders and major depression of "3/4" on "distress" score and "2/3" on "impact," the sensitivity and specificity were 0.82 and 0.82, respectively. Screening performance of the Distress and Impact Thermometer was comparable to that of the Hospital Anxiety and Depression Scale. Its brevity and good performance suggest that the Distress and Impact Thermometer is an effective tool for routine screening in clinical oncology settings.

BACKGROUNDAdjustment disorders and major depression are common psychiatric disorders in patients with cancer and have a serious impact on quality of life. The problem in clinical oncology settings is underrecognition of these disorders; as a result, screening is recommended to detect them. The goal of the current study was to develop a new, brief screening tool for adjustment disorders and major depression and to compare its performance with that of existing screening methods.METHODSPatients with cancer completed the newly developed One‐Question Interview (a 1‐item, structured interview); the Distress Thermometer (a 1‐item, self‐report questionnaire), which previously was developed as a brief screening tool; and the Hospital Anxiety and Depression Scale (HADS; a 14‐item, self‐report questionnaire). Psychiatric diagnoses of adjustment disorders and major depression were made by psychiatrists and were based on criteria set forth by the Diagnostic and Statistical Manual of Mental Disorders, 4th edition.RESULTSTwo hundred seventy‐five patients participated in the study. Scores on both the One‐Question Interview and the Distress Thermometer were significantly correlated with HADS score (One‐Question Interview: r = −0.66, P < 0.01; Distress Thermometer: r = 0.71, P < 0.01). At the optimal cutoff points, the sensitivity and specificity for detection of adjustment disorders and major depression were 80% and 61%, respectively, for the One‐Question Interview; 84% and 61%, respectively, for the Distress Thermometer; and 92% and 57%, respectively, for the HADS.CONCLUSIONSThe results of the current study suggested that the One‐Question Interview was a valid tool for use in screening patients with cancer for adjustment disorders and major depression. Its performance was inferior to that of the HADS but comparable to that of the Distress Thermometer. The One‐Question Interview may be suitable for widespread use in routine screening. Cancer 2003;10:2605–13. © 2003 American Cancer Society.DOI 10.1002/cncr.11358

A low level of personal accomplishment was relatively high among Japanese physicians compared with previous studies. Insufficient confidence in the psychological care of patients was associated with physician burnout rather than involvement in end-of-life care.

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The four domains of good patient-physician communication in Japan are apparently similar to those in Western countries. The domain involving information given and method of disclosure in previous Western studies was further divided into two domains in the present study. Japanese physicians should perhaps pay careful attention to these issues when disclosing bad news about cancer. There are some cultural differences related to the details of communication attributes (e.g. using euphemisms and showing consideration for the patient's family).

The DISPAC program is useful for facilitating the care of cancer patients with psychological distress. Nevertheless, the acceptance of referrals by patients and the reduction of the burden placed on nurses are areas requiring improvement.

The CST is feasible for Japanese oncologists, but it needs to be modified to reduce emotional-exhaustion.