Most patients with cancer and other serious illnesses want more information than their physicians offer, which frequently leads to unnecessary distress and feelings of hopelessness, an Australian research team reports.
In one cancer program, for example, 75 percent of elderly patients said their doctors created undue worry by not providing them with sufficient information; 40 percent of cancer patients in another study felt they were not fully informed about their diagnosis, prognosis, and treatment.
"Health professionals believe that breaking bad news is an important task, but they feel inadequately trained to do it effectively," according to Dr. Rob W. Sanson-Fisher and colleagues at the New South Wales Cancer Council Education Research Program, writing in a series of articles in the summer issue of Behavioral Medicine.
Although some physicians believe that hearing bad news can be sufficiently upsetting to harm a patient's health, the evidence points in the opposite direction, Dr. Sanson-Fisher and his colleagues say.
Patients may be seriously upset after learning a diagnosis of cancer, but most adjust well in the long term. "In fact, uncertainty is a major cause of emotional distress for patients; relief from this uncertainty can, in itself, be therapeutic," the investigators say.
Studies do show that the way patients are told bad news can exacerbate the distress they feel. Breaking bad news abruptly, over the telephone, or in the recovery room can prove especially distressing, Dr. Sanson-Fisher and colleagues say.
Many patients also react negatively when they feel physicians have withheld information or have not told them about other sources of help. Findings such as these have lead to medical school courses in how to break bad news and development of guidelines. Among the essential steps outlined by the Australian team:
- Give the patient the diagnosis honestly but not bluntly.
- Encourage patients to express their feelings.
- Offer a broad but realistic time frame for the prognosis.
- Discuss the treatment options. Avoid the notion that "nothing more can be done."
- Arrange another time to review the situation.
- Provide information about support services.
While guidelines help establish the minimum level of care that patients can expect to receive, the challenge remains to design effective programs to convey bad news, the researchers say. Programs studied in 10 randomized controlled trials "had little effect on psychological adjustment and inconsistent effects on patient knowledge and satisfaction with their care," they say in a second article in the journal.
Another challenge is to persuade physicians to abandon old habits and adopt new techniques. "Given the difficulty in altering clinical behavior, it is not reasonable to expect that widespread adoption will be achieved by simply producing best-practice guidelines," Dr. Sanson-Fisher and colleagues say in a third article of the series.
Behavioral Medicine is a quarterly journal edited and peer-reviewed by an international team of scientists who research the linkages between human behavior and health. For information about the journal, contact Executive Editor C. David Jenkins, PhD, at 919-968-0704.
Posted by the Center for the Advancement of Health http://www.cfah.org. For information about the Center, contact Richard Hebert, rhebert@cfah.org, at 202-387-2829.
Journal
Behavioral Medicine