Thursday, July 8, 2010

COMMUNICATING A CANCER DIAGNOSIS

More than twenty percent of patients are told of their cancer diagnosis in an impersonal manner, according to a study related by Shari Roan in the Los Angeles Times July 6. 

Researchers at the National Cancer Institute and Columbia University gave a questionnaire to 437 patients who had received a cancer diagnosis. Fifty-four percent had been told their diagnosis in person in the doctor's office. 28% got the news while in the hospital and 18% by phone. 

Patients who heard their diagnosis in person had much higher satisfaction scores than those who received the diagnosis over the phone. Subsequent conversations 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 radiology suite. 

Only a small percentage of patients reported very poor communication and lack of trust in their doctor. One patient described a message her doctor left on her answering machine: “…he called me on Valentine’s day to say I had a lesion in my chest…”

Leaving news of cancer on someone’s answering machine astounds me, considering what that message can mean to the listener. (Two people told me of this happening to them, both on a Friday afternoon, leaving them to stew over a long, long weekend before they could contact the doctor and ask questions.)

Sometimes it might be appropriate to inform patients via a phone call, but in any case an ensuing conversation is absolutely essential. In this study, 45% of the patients reported discussions of 10 minutes or less. Treatment options 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. 

A study conclusion was that “…too many physicians are either unaware of or not practicing good communication skills in such bad news circumstances.”

All this suggests that in many cases, neither patients nor doctors are prepared to discuss the issues that decorate a serious diagnosis. Since virtually anyone can suddenly hear they have cancer or some other serious disease (or, really, any bad news), it’s worthwhile to read the National Cancer Institute’s excellent post-diagnosis guide, at http://www.cancer.gov/cancertopics/takingtime/page2.

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