DOI QR코드

DOI QR Code

Breaking Bad News: Patient Preferences and the Role of Family Members when Delivering a Cancer Diagnosis

  • Rao, Abha (St. John's Research Institute) ;
  • Sunil, Bhuvana (St. John's Research Institute) ;
  • Ekstrand, Maria (Department of Medicine, University of California) ;
  • Heylen, Elsa (Department of Medicine, University of California) ;
  • Raju, Girish (Department of Medical Oncology, St. John's Medical College Hospital) ;
  • Shet, Arun (St. John's Research Institute)
  • Published : 2016.06.01

Abstract

Background: Western physicians tend to favour complete disclosure of a cancer diagnosis to the patient, while non-Western physicians tend to limit disclosure and include families in the process; the latter approach is prevalent in clinical oncology practice in India. Few studies, however, have examined patient preferences with respect to disclosure or the role of family members in the process. Materials and Methods: Structured interviews were conducted with patients (N=127) in the medical oncology clinic of a tertiary referral hospital in Bangalore, India. Results: Patients ranged in age from 18-88 (M=52) and were mostly male (59%). Most patients (72%) wanted disclosure of the diagnosis cancer, a preference significantly associated with higher education and English proficiency. A majority wanted their families to be involved in the process. Patients who had wanted and not wanted disclosure differed with respect to their preferences regarding the particulars of disclosure (timing, approach, individuals involved, role of family members). Almost all patients wanted more information concerning their condition, about immediate medical issues such as treatments or side effects, rather than long-term or non-medical issues. Conclusions: While most cancer patients wanted disclosure of their disease, a smaller group wished that their cancer diagnosis had not been disclosed to them. Regardless of this difference in desire for disclosure, both groups sought similar specific information regarding their cancer and largely favoured involvement of close family in decision making. Additional studies evaluating the influence of factors such as disease stage or family relationships could help guide physicians when breaking bad news.

Keywords

Cancer disclosure;patient preferences;role of families;India

Acknowledgement

Supported by : wellcome trust DBT India Alliance

References

  1. Akabayashi A, Fetters MD, Elwyn TS (1999). Family consent, communication, and advance directives for cancer disclosure: A Japanese case and discussion. J Med Ethics, 25, 296-301. https://doi.org/10.1136/jme.25.4.296
  2. Baile WF, Buckman R, Lenzia R, et al (2000). SPIKES: A sixstep protocol for delivering bad news: Application to the patient with cancer. Oncologist, 5, 302-11. https://doi.org/10.1634/theoncologist.5-4-302
  3. Benson J, Britten N (1996). Respecting the autonomy of cancer patients when talking with their families: Qualitative analysis of semi-structured interviews with patients. BMJ, 313, 729-31. https://doi.org/10.1136/bmj.313.7059.729
  4. Chaturvedi SK, Loiselle CG, Chandra PS (2009). Communication with relatives and collusion in palliative care: A crosscultural perspective. Ind J Pall Care, 15, 2-9. https://doi.org/10.4103/0973-1075.53485
  5. Chaturvedi SK, Strohschein FJ, Saraf G, Loiselle CG (2014). Communication in cancer care: Psycho-social, interactional, and cultural issues. A general overview and the example of India. Front Psychol, 5, 1332.
  6. Dikshit R, Gupta PC, Ramasundarahettige C, et al (2012). Cancer mortality in India: a nationally representative survey. Lancet, 379, 1807-16. https://doi.org/10.1016/S0140-6736(12)60358-4
  7. Eng TC, Yaakup H, Shah SA, Jaffar A, Omar K (2009). Preferences of Malaysian cancer patients in communication of bad news. Asian Pac J Cancer Prev, 13, 2749-52.
  8. Ferlay J, Shin HR, Bray F, et al (2010). Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer, 127, 2893-917. https://doi.org/10.1002/ijc.25516
  9. Ferlay J, Soerjomataram I, Dikshit R, et al (2015). Cancer incidence and mortality worldwide: Sources, methods, and major patterns in GLOBOCAN 2012. Int J Cancer, 136, 359-86. https://doi.org/10.1002/ijc.29210
  10. Fujimori M, Uchitomi Y (2009). Preferences of cancer patients regarding communication of bad news: A systematic literature review. Jpn J Clin Onc, 39, 201-16. https://doi.org/10.1093/jjco/hyn159
  11. Garg A, Buckman R, Kason Y (2000). Teaching medical students how to break bad news. Can Med Assoc J, 156, 1159-64.
  12. Gattellari M, Butow PN, Tattersall MHN, Dunn SM, MacLeod CA (1999). Misunderstanding in cancer patients: Why shoot the messenger? Ann Oncol, 10, 39-46. https://doi.org/10.1023/A:1008336415362
  13. Ghooi RB, Deshpande SR (2012). Patients’ rights in India: An ethical perspective. Ind J Med Ethics, 9, 277-81.
  14. Grassi L, Giraldi T, Messina EG, et al (2000). Physicians’ attitudes to and problems with truth-telling to cancer patients. Supp Care Cancer, 8, 40-5.
  15. Kazdaglis GA, Arnaoutoglou C, Karypidis D, et al (2010). Disclosing the truth to terminal cancer patients: A discussion of ethical and cultural issues. East Mediterranean Hlth J, 16, 442-7.
  16. Kumar M, Goyal S, Singh K, et al (2009). Breaking bad news issues: A survey among radiation oncologists. Ind J Pall Care, 15, 61-6. https://doi.org/10.4103/0973-1075.53533
  17. Laxmi S, Khan AJ (2013). Does the cancer patient want to know? Results from a study in an Indian tertiary care center. S Asian J Cancer, 2, 57-61. https://doi.org/10.4103/2278-330X.110487
  18. Lee A, Wu HY (2002). Diagnosis disclosure in cancer patients - when the family says No! Singapore Med J, 43, 533-8.
  19. Masaki S, Ishimoto H, Asai A (2014). Contemporary issues concerning informed consent in Japan based on a review of court decisions and characteristics of Japanese culture. BMC Med Ethics, 15, 8. https://doi.org/10.1186/1472-6939-15-8
  20. Mitchell JL (1998). Cross-cultural issues in the disclosure of cancer. Cancer Prac, 6, 153-60. https://doi.org/10.1046/j.1523-5394.1998.006003153.x
  21. Miyata H, Tachimori H, Takahashi H, Saito T, Kai I (2004). Disclosure of cancer diagnosis and prognosis: A survey of the general public's attitudes towards doctors and family holding discretionary powers, BMC Med Ethics, 5, 7. https://doi.org/10.1186/1472-6939-5-7
  22. Miyata H, Takahashi M, Saito T, Tachimori H, Kai I (2005). Disclosure preferences regarding cancer diagnosis and prognosis: to tell or not to tell? J Med Ethics, 31, 447-51. https://doi.org/10.1136/jme.2003.007302
  23. Rizalar S, Ozbas A, Akyolcu N, Gungor B (2014). Effect of perceived social support on psychosocial adjustment of Turkish patients with breast cancer. Asian Pac J Cancer Prev, 15, 3429-34. https://doi.org/10.7314/APJCP.2014.15.8.3429
  24. Russell BJ, Ward AM (2011). Deciding what information is necessary: Do patients with advanced cancers want to know all the details? Cancer Mgmt Res, 3, 191-99.
  25. Searight HR, Gafford J (2005). Cultural diversity at the end of life: Issues and guidelines for family physicians. Am Fam Phys, 71, 515-22.
  26. Tesser A, Rosen S, Tesser M (1971). On the reluctance to communicate undesirable messages (the MUM effect): A field study. Psych Rep, 29, 651-4. https://doi.org/10.2466/pr0.1971.29.2.651
  27. The AM, Hak T, Koëter G, van der Wal G (2000). Collusion in doctor-patient communication about imminent death: An ethnographic study. BMJ, 321, 1376-81. https://doi.org/10.1136/bmj.321.7273.1376
  28. Yun YH, Lee CG, Kim SY, et al (2004). The attitudes of cancer patients and their families toward the disclosure of terminal illness. J Clin Onc, 22, 307-14. https://doi.org/10.1200/JCO.2004.07.053
  29. Yun YH, Kwon YC, Lee MK, et al (2010). Experiences and attitudes of patients with terminal cancer their family caregivers toward the disclosure of terminal illness. J Clin Onc, 28, 1950-7. https://doi.org/10.1200/JCO.2009.22.9658

Cited by

  1. Breaking Bad News: An Evidence-Based Review of Communication Models for Oncology Nurses vol.21, pp.5, 2017, https://doi.org/10.1188/17.CJON.573-580
  2. Association between socio-demographic factors, coping style, illness perceptions and preference for disclosure/nondisclosure of diagnosis in Chinese patients with hepatocellular carcinoma pp.1461-7277, 2017, https://doi.org/10.1177/1359105317707258