Psychological responses of patients receiving a diagnosis of cancer.
BACKGROUND
Current recommendations on how to break bad news are primarily based on expert opinion. Little is known about the association between communication practices and patients' psychological response.


METHODS
One-hundred and thirty-one patients with newly diagnosed melanoma were surveyed 4 months after the initial consultation at the Sydney Melanoma Unit regarding their communication experiences and their satisfaction with these experiences. They completed the Hospital Anxiety and Depression Scale (HADS) at this time, and 4 and 13 months later.


RESULTS
Both patients' satisfaction with communication and their psychological morbidity were found to be associated with particular communication practices. Practices linked to lower anxiety included preparing the patient for a possible diagnosis of cancer; having the people wanted by the patient present to hear the diagnosis; giving the patient as much information about the diagnosis as desired; providing written information; presenting the information clearly; discussing the patient's questions the same day; talking about the patient's feelings; and being reassuring. Practices linked with lower levels of depression included using the word 'cancer'; discussing the severity of the situation, life expectancy and how the cancer might affect other aspects of life; and encouraging the patient to be involved in treatment decisions.


CONCLUSIONS
This study provided preliminary evidence that communication strategies recommended in the literature produce positive patient outcomes. Further studies are needed which document actual communication.
Schofield
P E
PE
Department of Haematology & Medical Oncology, Peter MacCallum Cancer Institute, Victoria, Australia. penelope.schofield@petermac.org
Butow
P N
PN
Thompson
J F
JF
Tattersall
M H N
MH
Beeney
L J
LJ
Dunn
S M
SM
D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety; D003142:Communication; D003717:Denial, Psychological; D004644:Emotions; D005260:Female; D006117:Grief; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000523:psychology*; D008875:Middle Aged; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011379:Prognosis; D012017:Referral and Consultation; D012878:Skin Neoplasms / Q000175:diagnosis / Q000523:psychology*; D011795:Surveys and Questionnaires; D014342:Truth Disclosure