Misunderstanding in cancer patients: Why shoot the messenger?

Abstract

SummaryAim: We aimed to document the prevalence of misunderstanding in cancer patients and investigate whether patient denial is related to misunderstanding.Patients and methods: Two hundred forty-four adult cancer outpatients receiving treatment completed a survey assessing levels of understanding and denial. Doctors provided the facts against which patient responses were compared. Multiple logistic regression analyses determined the predictors of misunderstanding.Results: Most patients understood the extent of their disease (71%, 95% CI: 65%-77%) and goal of treatment (60%, 95% CI: 54%-67%). Few correctly estimated the likelihood of treatment achieving cure (18%, 95% CI: 13%-23%), prolongation of life (13%, 95% CI: 8%-17%) and palliation (18%, 95% CI: 10%-27%). Patient denial predicted misunderstanding of the probability that treatment would cure disease when controlling for other patient and disease variables (OR = 2.20, 95% CI: 0.99-4.88, P = 0.05). Patient ratings of the clarity of information received were also predictive of patient understanding.Conclusions:Patient denial appears to produce misunderstanding, however, doctors' ability to communicate effectively is also implicated. The challenge that oncologists face is how to communicate information in a manner which is both responsive to patients' emotional status and sufficiently informative to allow informed decision-making to take place.

Enhancing treatment decision-making: pilot study of a treatment decision aid in stage IV non-small cell lung cancer

“…The impact of treatment on patient's quality of life was discussed in only onethird of consultations, and oncologists checked for patient understanding of information in only 10%. Even when all relevant information is discussed with their oncologists, as many as a third of patients misunderstand this information (Gattellari et al, 1999). This should not surprise oncologists, given the amount and complexity of information to review, the anxiety and distress associated with a diagnosis of advanced cancer and possible coping strategies, such as denial.…”

Deciding what information is necessary: do patients with advanced cancer want to know all the details?

“…[47][48][49] Distress and denial are known to reduce the amount of information patients retain after conversations with physicians. 50,51 Data from the Australian and American contexts have shown that age and gender do not appear to be significant factors in comprehension, but patients who have not completed secondary school and for whom English is a second language are less likely to have concordance with their physician. 51,52 Physicians may overestimate patient understanding, 53 and Australian oncologists have been reported to seek confirmation of understanding in only 10% of consultations.…”

“…50,51 Data from the Australian and American contexts have shown that age and gender do not appear to be significant factors in comprehension, but patients who have not completed secondary school and for whom English is a second language are less likely to have concordance with their physician. 51,52 Physicians may overestimate patient understanding, 53 and Australian oncologists have been reported to seek confirmation of understanding in only 10% of consultations. 35 Patients may be reluctant to ask for clarification, particularly when there is a language barrier.…”

Patient perspectives regarding communication about prognosis and end-of-life issues: How can it be optimised?

“…Many patients do not discuss their prognosis or concerns regarding end-of-life care with their doctor or family [3][4][5]. Lack of such discussions and sub-optimal communication can contribute to poor decision-making and outcomes at the end-of-life.…”