Annals of Oncology 14:48-56, 2003
© 2003 European Society for Medical Oncology
Original Paper |
Psychological responses of patients receiving a diagnosis of cancer
1 Department of Haematology & Medical Oncology, Peter MacCallum Cancer Institute, Victoria; 2 Medical Psychology Research Unit, University of Sydney, NSW; 3 Department of Surgery, University of Sydney and Sydney Melanoma Unit, Gloucester House, Royal Prince Alfred Hospital, Camperdown, NSW; 4 Department of Cancer Medicine, University of Sydney, NSW; 5 Department of Psychology, University of Sydney, NSW; 6 Department of Psychological Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia
Received 14 February 2002; revised 9 July 2002; accepted 18 July 2002
Background:
Current recommendations on how to break bad news are primarily based on expert opinion. Little is known about the association between communication practices and patients’ psychological response.
Patients and methods:
One-hundred and thirty-one patients with newly diagnosed melanoma were surveyed 4 months after the initial consultation at the Sydney Melanoma Unit regarding their communication experiences and their satisfaction with these experiences. They completed the Hospital Anxiety and Depression Scale (HADS) at this time, and 4 and 13 months later.
Results:
Both patients’ satisfaction with communication and their psychological morbidity were found to be associated with particular communication practices. Practices linked to lower anxiety included preparing the patient for a possible diagnosis of cancer; having the people wanted by the patient present to hear the diagnosis; giving the patient as much information about the diagnosis as desired; providing written information; presenting the information clearly; discussing the patient’s questions the same day; talking about the patient’s feelings; and being reassuring. Practices linked with lower levels of depression included using the word ‘cancer’; discussing the severity of the situation, life expectancy and how the cancer might affect other aspects of life; and encouraging the patient to be involved in treatment decisions.
Conclusions:
This study provided preliminary evidence that communication strategies recommended in the literature produce positive patient outcomes. Further studies are needed which document actual communication.
Key words: breaking bad news, communication, diagnosis, melanoma, psychological adjustment, truth telling
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