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Cancer Health Center

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Communication in Cancer Care (PDQ®): Supportive care - Health Professional Information [NCI] - Unique Aspects of Communication with Cancer Patients


Research has attempted to characterize different information styles in a variety of ways. One of these is monitoring and blunting.[23] Monitors actively seek information, whereas blunters avoid or distract themselves from information. For example, one study [24] found that having a monitoring style was related to a preference for detailed information, participation in medical decision making, and patient question-asking. Thus, patient information style may greatly affect patient communication preferences and patient interactions with health care providers. This area warrants additional study and has implications for how patients adjust to their cancer experience.

Participation Styles in Decision Making

Participation style in decision making represents how much patients want to be involved in the decision-making process related to their cancer. Studies of patient desire to participate in treatment decisions have yielded conflicting results, largely depending on how participation in decision making is defined. Participation can range from the patient actively engaging in the decision-making process, to the patient wanting the doctor to make the ultimate decision.[25] The desire to participate in treatment decisions is associated with locus of control, which describes how an individual tends to attribute control. Patients with an internal locus of control seek information to control their own destinies, whereas those with an external locus of control tend to passively accept their lot.[26]

Because research shows that a range of patient decision making exists, increasing participation for all patients may not be the most effective strategy. One study [27] categorized patients with early-stage breast cancer into the following groups:

  • Delayers, who consider at least two options, but their deliberation is perfunctory and they immediately prefer one option.
  • Deferrers, who accept their doctors' recommendations without a significant degree of reflection.
  • Deliberators, who weigh the pros and cons of each treatment and do not make a choice until they have considered all the relevant information and have found an alternative with which they are satisfied.

Another study [28] identified the following four patterns to describe how patients' emotional styles affected treatment decision making:

  • Passive.
  • Avoidant.
  • Panicked.
  • Rational.

Passive decision makers allowed directive physicians to make treatment choices for them. They responded more to the caring attitude of their provider and the need to have someone to believe in rather than to an opportunity for autonomous decision making. Women with breast cancer using an avoidant style of decision making refused to actively confront their diagnosis or participate in planning their cancer treatment. Panicked patients were so fearful when confronted with a diagnosis of cancer that they could not participate in decision making, whereas rational decision makers were able to control strong feelings of fear and engage fully in decision making.[28]

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