Patient relations: Best practices for delivering a cancer diagnosis

While telling a patient he or she has cancer will never be easy, a new study by researchers from the National Cancer Institute and Columbia University offers some best practices for delivering the difficult news. The study, published this week in the Journal of Clinical Oncology, concluded that in general, doctors should disclose a cancer diagnosis in a personal setting, taking plenty of time to discuss what the diagnosis means and explain treatment options.

By tabulating the results of a questionnaire given to 437 patients who received a cancer diagnosis, the researchers found that 54 percent of patients were told their diagnosis in person in the doctor's office, while 18 percent got the news by phone and 28 percent while in the hospital.

Perhaps more surprising, the Los Angeles Times notes, is that 45 percent of the patients reported discussions of 10 minutes or less. Treatment options were not discussed in 31 percent of the conversations. In 39 percent of the cases, the patient had no support person present when receiving the news.

When asked how satisfied they were with the way the cancer diagnosis was delivered, the average score on a scale from zero to 100 (the most satisfied) was 73.5. Patients who heard their diagnosis in person had much higher satisfaction scores than those who received the diagnosis over the phone, while conversations that took place in the doctor's office were rated higher by patients than talks that took place in a 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.

Nonetheless, "...having more than 20 percent of patients told their diagnosis in an impersonal manner suggests too many physicians are either unaware of or not practicing good communication skills in such bad news circumstances," the authors wrote.

And as a piece in yesterday's Wall Street Journal points out, physicians should avoid medical jargon when talking to patients whenever possible, even if they seem medically savvy. According to the Centers for Disease Control and Prevention, nearly nine out of 10 adults have difficulty following routine medical advice, largely because it's often incomprehensible to average people.

Being able to understand medical information is especially important for patients diagnosed with a serious illness, Donald Kempler, chief executive of Healthwise, a nonprofit provider of interactive health-information materials, told the newspaper.

While medical jargon has always posed a challenge for patients, the issue has become more urgent with advances in medicine that have made treatment decisions more complex. Thus, a new federal program called the Health Literacy Action Plan is promoting simplified language nationwide. And some health insurers, physician practices and hospitals have begun using specialized software that scans documents looking for hard-to-understand words and phrases and suggests plain-English replacements. For example, a patient-consent form warning of hyperpyrexia after a procedure might be translated to an abnormally high fever.

To learn more:
- read this piece in the Los Angeles Times
- see the study in the Journal of Clinical Oncology
- check out this article in the Wall Street Journal

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