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Many Docs Deliver Cancer Diagnosis Badly: Study
Date:7/7/2010

By Ellin Holohan
HealthDay Reporter

WEDNESDAY, July 7 (HealthDay News) -- One patient found out he had cancer by reading his radiology report.

Another got the news when her neurologist called to say he had arranged for her to see a neurosurgeon. When she asked why, the doctor told her she had a brain tumor and hung up.

A third learned she had breast cancer listening to her answering machine with her grandson sitting on her lap.

A new study about how people learn of cancer diagnoses finds that many doctors have poor communication skills and often leave patients stranded with devastating information about a deadly illness, sometimes in a public setting.

One-third of the cancer patients in the U.S. National Cancer Institute study recalled being told on the phone, in an emergency room, radiology department or other public hospital setting that they had cancer, most often leukemia, lymphoma or brain tumors.

"It's really dismaying to think that many patients are told they have cancer in an impersonal way. As physicians, not all of us, but too many, don't have that degree of compassion," said Dr. J. Leonard Lichtenfeld, deputy chief medical officer for the American Cancer Society.

"It's not acceptable," he added.

The study, published online July 6 in the Journal of Clinical Oncology, asked patients where they learned of their diagnosis, how long their doctor talked to them, whether treatment options were discussed and how satisfied they were with the experience.

Only 54 percent said they found out they had cancer in person in a doctor's office. Eighteen percent learned over the phone, while the remaining 28 percent were told in various hospital locations, often with little privacy. Nearly half reported discussions of 10 minutes or less, while one-third said treatment options were not reviewed. Thirty-nine percent said they had no one with them when given the diagnosis. A total of 437 patients responded to the written survey.

The more impersonal the setting and the less time spent, the less satisfied patients felt. When treatment options were not discussed, patients were also dissatisfied.

"We need to understand patients, when they feel comfortable when told of a diagnosis, and what are the settings that make them feel comfortable," said study author Dr. William D. Figg, senior investigator at the U.S. National Cancer Institute in Bethesda, Md. "It's better when we can tell them face-to-face when there is a troubling diagnosis because it will better enable them to cope."

Of the 57 percent who changed doctors after the diagnosis, patients gave various reasons including a desire to receive treatment at another facility, participate in experimental trials or get treatment closer to home. But among those who changed, 15 percent said they had lost trust in their physicians, 10 percent blamed poor communication and 12 percent noted general dissatisfaction. Patients were allowed to give more than one reason for changing doctors.

On a scale from zero to 100, the median satisfaction score given by patients in the way they learned of their cancer was 74 percent. Nearly 80 percent reported a greater than a neutral level of trust in their doctor, with 16 percent expressing "absolute trust."

Before the 1970s, doctors often concealed a cancer diagnosis from their patients, according to background information in the study. Disclosure is now routine, but physicians should try to relay the findings in a personal setting and allow time to discuss the diagnosis and means of treatment, the study authors suggest.

The authors say it is sometimes appropriate to relay a cancer diagnosis over the phone, for example, when "results of a final test may confirm a cancer diagnosis" and waiting to schedule an appointment would be undesirable. Doctors also might want to tell a patient in an emergency room when a blood test confirms a leukemia diagnosis, the report indicated.

But the study concludes that "too many physicians are either unaware of or not practicing good communication skills in such bad news circumstances."

Figg and Lichtenfeld said doctors sometimes conveyed serious diagnoses in impersonal ways because they lacked long-term relationships with their patients.

"That doesn't excuse the behavior," said Lichtenfeld. Doctors are "losing that sensitivity in our training," and the problem is "ingrained in the culture" of the profession, he added.

Most doctors "want to help their patients, to heal them, to cure them, but some of our colleagues are not doing what they need to do," Lichtenfeld said.

More training is needed to help doctors learn the best ways to deliver bad news, he suggested.

More information

The U.S. National Cancer Institute can help you understand your cancer prognosis.

SOURCES: J. Leonard Lichtenfeld, M.D., deputy chief medical officer, American Cancer Society, Atlanta; William D. Figg, M.D., senior investigator, U.S. National Cancer Institute, Bethesda, Md.; July 6, 2010, Journal of Clinical Oncology, online


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