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Communication in Cancer Care (PDQ®): Supportive care - Health Professional Information [NCI] - Communication Along the Disease Trajectory

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Some general guidelines and recommendations for how bad news interviews should be conducted have been published.[4,19,41,42,43] However, these recommendations have usually taken the form of practical advice formulated on the basis of anecdotal experiences or opinions with little empirical foundation. For example, in one review of more than 300 articles from the published literature between 1973 and 1993, only 23.2% of authors reported descriptive data on breaking bad news, and almost two thirds were opinions, reviews, letters, case reports, or non–data-based descriptive studies.[39] Although there are some subtle differences between approaches recommended for giving bad news, there are also many common elements. For example, each of the strategies referenced above recommends giving the news in an appropriate setting (quiet place, with uninterrupted time), assessing the patient's understanding of their illness, providing the information the patient wants, allowing the patient to express emotions and responding appropriately, summarizing the information provided, and coming up with a plan for the next step(s). Additional research is needed to empirically support these techniques.

Research also suggests that the structure and content of the consultation influences the patient's ability to remember what has been said in the following ways:[16]

  • Patients usually recall facts provided at the start of a consultation more readily than those given later.
  • Topics deemed most relevant and important to the patient (which might not be those considered most pertinent to the doctor) are recalled most accurately.
  • The larger the number of statements made by a doctor, the smaller the mean percentage recalled by the patient.
  • Items that patients manage to recall do not decay over time, as do other memories.

References:

  1. Baile WF, Aaron J: Patient-physician communication in oncology: past, present, and future. Curr Opin Oncol 17 (4): 331-5, 2005.
  2. Lee SJ, Back AL, Block SD, et al.: Enhancing physician-patient communication. Hematology Am Soc Hematol Educ Program : 464-83, 2002.
  3. Frankel RM, Stein T: Getting the most out of the clinical encounter: the four habits model. J Med Pract Manage 16 (4): 184-91, 2001 Jan-Feb.
  4. Baile WF, Buckman R, Lenzi R, et al.: SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer. Oncologist 5 (4): 302-11, 2000.
  5. Hietanen P, Aro AR, Holli K, et al.: Information and communication in the context of a clinical trial. Eur J Cancer 36 (16): 2096-104, 2000.
  6. Buckman R: Communications and emotions. BMJ 325 (7366): 672, 2002.
  7. Wallace JA, Hlubocky FJ, Daugherty CK: Emotional responses of oncologists when disclosing prognostic information to patients with terminal disease: results of qualitative data from a mailed survey to ASCO members. [Abstract] J Clin Oncol 24 (Suppl 18): A-8520, 2006.
  8. Maguire P: Improving communication with cancer patients. Eur J Cancer 35 (10): 1415-22, 1999.
  9. Miller SM: Monitoring and blunting: validation of a questionnaire to assess styles of information seeking under threat. J Pers Soc Psychol 52 (2): 345-53, 1987.
  10. Novack DH, Plumer R, Smith RL, et al.: Changes in physicians' attitudes toward telling the cancer patient. JAMA 241 (9): 897-900, 1979.
  11. Gordon EJ, Daugherty CK: 'Hitting you over the head': oncologists' disclosure of prognosis to advanced cancer patients. Bioethics 17 (2): 142-68, 2003.
  12. Arber A, Gallagher A: Breaking bad news revisited: the push for negotiated disclosure and changing practice implications. Int J Palliat Nurs 9 (4): 166-72, 2003.
  13. Mitchell JL: Cross-cultural issues in the disclosure of cancer. Cancer Pract 6 (3): 153-60, 1998 May-Jun.
  14. Girgis A, Sanson-Fisher RW: Breaking bad news. 1: Current best advice for clinicians. Behav Med 24 (2): 53-9, 1998.
  15. Mishel MH: Reconceptualization of the uncertainty in illness theory. Image J Nurs Sch 22 (4): 256-62, 1990.
  16. Fallowfield L, Jenkins V: Effective communication skills are the key to good cancer care. Eur J Cancer 35 (11): 1592-7, 1999.
  17. Friedrichsen MJ, Strang PM, Carlsson ME: Cancer patients' interpretations of verbal expressions when given information about ending cancer treatment. Palliat Med 16 (4): 323-30, 2002.
  18. Loge JH, Kaasa S, Hytten K: Disclosing the cancer diagnosis: the patients' experiences. Eur J Cancer 33 (6): 878-82, 1997.
  19. Parker PA, Baile WF, de Moor C, et al.: Breaking bad news about cancer: patients' preferences for communication. J Clin Oncol 19 (7): 2049-56, 2001.
  20. Back AL, Trinidad SB, Hopley EK, et al.: What patients value when oncologists give news of cancer recurrence: commentary on specific moments in audio-recorded conversations. Oncologist 16 (3): 342-50, 2011.
  21. Butow PN, Dowsett S, Hagerty R, et al.: Communicating prognosis to patients with metastatic disease: what do they really want to know? Support Care Cancer 10 (2): 161-8, 2002.
  22. Lobb EA, Butow PN, Kenny DT, et al.: Communicating prognosis in early breast cancer: do women understand the language used? Med J Aust 171 (6): 290-4, 1999.
  23. Degner LF, Kristjanson LJ, Bowman D, et al.: Information needs and decisional preferences in women with breast cancer. JAMA 277 (18): 1485-92, 1997.
  24. Helft PR: Necessary collusion: prognostic communication with advanced cancer patients. J Clin Oncol 23 (13): 3146-50, 2005.
  25. Back AL, Arnold RM: Discussing prognosis: "how much do you want to know?" talking to patients who are prepared for explicit information. J Clin Oncol 24 (25): 4209-13, 2006.
  26. Back AL, Arnold RM: Discussing prognosis: "how much do you want to know?" talking to patients who do not want information or who are ambivalent. J Clin Oncol 24 (25): 4214-7, 2006.
  27. Back AL, Arnold RM, Quill TE: Hope for the best, and prepare for the worst. Ann Intern Med 138 (5): 439-43, 2003.
  28. Dowsett SM, Saul JL, Butow PN, et al.: Communication styles in the cancer consultation: preferences for a patient-centred approach. Psychooncology 9 (2): 147-56, 2000 Mar-Apr.
  29. Ellis PM, Tattersall MH: How should doctors communicate the diagnosis of cancer to patients? Ann Med 31 (5): 336-41, 1999.
  30. Sardell AN, Trierweiler SJ: Disclosing the cancer diagnosis. Procedures that influence patient hopefulness. Cancer 72 (11): 3355-65, 1993.
  31. Adelbratt S, Strang P: Death anxiety in brain tumour patients and their spouses. Palliat Med 14 (6): 499-507, 2000.
  32. Zhang B, Wright AA, Huskamp HA, et al.: Health care costs in the last week of life: associations with end-of-life conversations. Arch Intern Med 169 (5): 480-8, 2009.
  33. Byock IR: The nature of suffering and the nature of opportunity at the end of life. Clin Geriatr Med 12 (2): 237-52, 1996.
  34. Singer PA, Martin DK, Kelner M: Quality end-of-life care: patients' perspectives. JAMA 281 (2): 163-8, 1999.
  35. Steinhauser KE, Christakis NA, Clipp EC, et al.: Factors considered important at the end of life by patients, family, physicians, and other care providers. JAMA 284 (19): 2476-82, 2000.
  36. Chochinov HM, Hack T, Hassard T, et al.: Dignity in the terminally ill: a cross-sectional, cohort study. Lancet 360 (9350): 2026-30, 2002 Dec 21-28.
  37. Evans WG, Tulsky JA, Back AL, et al.: Communication at times of transitions: how to help patients cope with loss and re-define hope. Cancer J 12 (5): 417-24, 2006 Sep-Oct.
  38. Back AL, Arnold RM, Tulsky JA, et al.: On saying goodbye: acknowledging the end of the patient-physician relationship with patients who are near death. Ann Intern Med 142 (8): 682-5, 2005.
  39. Girgis A, Sanson-Fisher RW: Breaking bad news: consensus guidelines for medical practitioners. J Clin Oncol 13 (9): 2449-56, 1995.
  40. Bedell SE, Graboys TB, Bedell E, et al.: Words that harm, words that heal. Arch Intern Med 164 (13): 1365-8, 2004.
  41. Fallowfield LJ, Jenkins VA, Beveridge HA: Truth may hurt but deceit hurts more: communication in palliative care. Palliat Med 16 (4): 297-303, 2002.
  42. Loge JH, Kaasa S: [Occurrence and diagnosis of psychiatric conditions in palliative medicine] Tidsskr Nor Laegeforen 120 (27): 3275-9, 2000.
  43. Buckman R: How to Break Bad News: A Guide for Health Care Professionals. Baltimore, Md: Johns Hopkins University Press, 1992.
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WebMD Public Information from the National Cancer Institute

Last Updated: February 25, 2014
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.
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