title: The 'information spectrum': a qualitative study of how breast cancer surgeons give information and of how their patients experience it.
abstract: OBJECTIVE
  Cancer clinicians are routinely criticised for communicating information poorly to patients, but expert guidance is sometimes contradictory or impractical. We wanted to understand how, and how well, breast cancer surgeons in their normal practice balanced the competing tasks of informing patients while keeping them hopeful.
  
  
  METHODS
  In a post-operative surgical outpatient clinic in a UK breast unit, we recruited 9 surgeons and 20 breast cancer patients with whom they consulted. We audio recorded and interviewed both patients and surgeons about their consultations, then analysed data qualitatively within and across cases taking a constant comparative approach.
  
  
  RESULTS
  Every consultation contained biomedical factually explicit information, but the information that was most significant for patients was factually less explicit. Progressively less explicit forms, along a 'spectrum' of information, included: judgments about treatment implications; judgments about prognosis; evaluative comments; and clues about what information signified. Surgeons used the less explicit types of information to communicate hope. Where prognosis was poor, communication was confined to more explicit information. Surgeons' practice was closely aligned with what patients sought.
  
  
  CONCLUSIONS
  Common criticisms of cancer clinicians for giving 'too little' information belie the complexity of their task in simultaneously managing information needs and hope. The 'information spectrum' could help educators and clinicians to understand this task.
authors.affiliation: Division of Clinical Psychology, University of Liverpool, Liverpool, UK.
authors.forename: Nicola
authors.initials: N
authors.lastname: Mendick
authors.affiliation: Division of Clinical Psychology, University of Liverpool, Liverpool, UK.
authors.forename: Bridget
authors.initials: B
authors.lastname: Young
authors.affiliation: Breast Unit, Linda McCartney Centre, Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Holcombe
authors.affiliation: Division of Clinical Psychology, University of Liverpool, Liverpool, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Salmon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000523:psychology* / Q000601:surgery; D002277:Carcinoma / Q000523:psychology* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000523:psychology / Q000601:surgery; D003142:Communication; D005260:Female; D006801:Humans; D008875:Middle Aged; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D036301:Qualitative Research; D066231:Surgeons; D014342:Truth Disclosure
keywords: breast cancer; cancer; information‐giving; oncology; qualitative research