Breaking the Bad News of Cancer: The Patient's Perspective

Abstract

When patients are told of the diagnosis of head and neck cancer, they want their physician to be truthful, caring, and compassionate. The patients want their diagnosis in simple and direct terms without the incorporation of complex medical terminology. The results of this survey can provide insightful information to physicians when they are undertaking the difficult task of conveying bad news to their patients.

Communication with Physicians about Health Care Costs: Survey of an Insured Population

“…For example, some research indicates that the greater the match between the preferences of patients with breast cancer to be involved and their perception of actual involvement, the less deci sional regret and greater satisfac tion with care. 173,175 Patients' evalu ations of care are better predicted by perceptions of having had a shared role in decision-making than by their initial preferred role; 173,176 this may in part be due to their feelings of being involved in the process. Physician support of patient participation can increase the participation of patients with cancer, 29,177 foster a sense of having a choice of treatment, and lead to greater satisfaction with care.…”

“…172 Second, although the vast majority of physicians favor truth-telling, many feel uncomfort able about discussing dire prog noses 173 and intentionally exagger ate prognoses when communicat ing with patients and families. 174 Correspondingly, patients fre quently report not knowing their prognosis 95,175 or overestimate their prognosis, even when provided accurate information. 95,105,[176][177][178][179][180][181][182] In these studies, higher educational level, lower levels of depression, and higher patient ratings of their physician were associated with better understanding, but further research is needed to examine causal relationships among these factors.…”

Communication Strategies and Cultural Issues in the Delivery of Bad News

“…46,51 Family members often want to be involved in discussions of prognosis and bad news, yet the literature shows some patients want family present whereas others do not. [52][53][54][55][56][57] Alternatively, some patients may want bad news delivered to their family, trusting that their family will disclose to them what they feel is appropriate. It is important to respect patients' preferences, including who should be present and who should not, and to identify family dynamics regarding who will be involved in discussions, who will make decisions, and how consensus will be achieved.…”

Broken doctor–patient relationships: why won't they listen?

“…391 In one survey, most women with breast cancer said they would take this opportunity if it was offered. 85 In contrast, in a study of people with head and neck cancers, 81% did not want anyone else present at the time of diagnosis, 417 and another study found few melanoma patients had a preference for having another healthcare professional present at the time of diagnosis. 418 Therefore, the primary recommendation is to always check with each patient at each visit about their preferences.…”