Cancer diagnoses often given quickly, impersonally
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Almost 20% of cancer patients are informed of their diagnosis over the phone, and almost half are told in a conversation lasting less than 10 minutes, according to a recent survey.
The data were gathered from a questionnaire given to 460 oncology patients being treated at the National Institutes of Health (NIH) Clinical Center in Bethesda, Md. The surveyed patients had been referred to the NIH from around the U.S. and some foreign countries, and slightly more than a third of them had lymphoma and leukemia. Another 22% had brain cancer, 14% had prostate cancer and 27% had some other type of cancer.
More than half of the patients (54%) reported learning of their cancer diagnosis in a physician's office, while 18% learned over the phone and 28% were told in the hospital. Of the patients who were diagnosed in the hospital, 43% got the news in their room, 23% in the emergency department, 13% in the recovery room, 7% in the radiology department and 13% in other locations, including one patient who discovered the diagnosis by reading a radiology report.
As for the length of the conversation, 8% said it was less than a minute, 36% between 1 and 10 minutes, and 35% 11 to 30 minutes. About 30% of patients said there was no discussion of treatment options. The survey also asked how satisfied patients were with the way they were informed, and being informed in person and during a longer discussion were associated with greater satisfaction. Patients also reported anecdotes of the conversations, describing notifications that were left on answering machines or made on holidays.
The study authors acknowledged that some situations may require notification over the phone or in an impersonal location like an emergency department, but “having more than 20% of patients told their diagnosis in an impersonal manner suggests too many physicians are either unaware of or not practicing good communication skills,” they said. They recommended that the delivery of a cancer diagnosis be done face-to-face in a personal setting, last longer than 10 minutes, and include additional information beyond just the diagnosis, such as treatment options.
Patients who don't get such a conversation may be not only more dissatisfied with the experience, but also more likely to change physicians after the diagnosis. More than half of the studied patients changed physicians—many because of a referral—but 10% gave poor communication as a reason for switching and 12% cited general dissatisfaction. The study was published online by the Journal of Clinical Oncology on July 6.