title: Breaking bad news to cancer patients in palliative care: A comparison of national cross-sectional surveys from 2006 and 2012.
abstract: OBJECTIVE
  Most cancer patients experience the time when a doctor must "break the bad news" to them, a time when it is necessary for patients to call upon their self-determination to aid in the battle with cancer. The purpose of our study was to clarify the percentage of times doctors deliver bad news to patients at the end of life in each of four different situations, and to define the most common recipients of this bad news. We compare these results for two timepoints: 2006 and 2012.
  
  
  METHODS
  The study had a national cross-sectional design consisting of self-completed questionnaires sent to all hospitals that provide cancer care. We mailed them to hospital directors in January and February of 2012, requesting a reply. The results of the same survey in 2006 were employed as a point for comparison.
  
  
  RESULTS
  A total of 1224 questionnaires were returned during 2012. 1499 responses collected in 2006 were employed as reference data. Some hospital characteristics had changed over that interval; however, the new data obtained were representative for patients being treated in Japanese cancer care hospitals. In hospitals with 300-499, there were significant differences between 2006 and 2012 in the providing information about ("disclosure of cancer diagnosis," "therapeutic options for treatment," and "a life-prolonging treatment"). In addition, the likelihood of doctors delivering bad news to patients and family members (as opposed to family members only) at the end of life increased from 2006 to 2012.
  
  
  CONCLUSIONS
  Our results suggest that the overall incidence of bad news being disclosed has increased, especially in hub medical institutions for cancer care. Advanced treatment options or domestic legislation may have influenced the frequency or type of bad news.
authors.affiliation: Section of Liaison Psychiatry and Palliative Medicine,Graduate School of Medical and Dental Sciences,Tokyo Medical and Dental University,Tokyo,Japan.
authors.forename: Kanako
authors.initials: K
authors.lastname: Ichikura
authors.affiliation: Department of Hygiene and Public Health,Teikyo University School of Medicine,Tokyo,Japan.
authors.forename: Ayako
authors.initials: A
authors.lastname: Matsuda
authors.affiliation: Education and Research Support Center,Toho University,Tokyo,Japan.
authors.forename: Mika
authors.initials: M
authors.lastname: Kobayashi
authors.affiliation: Graduate School of Media andn Governance,Keio University,Kanagawa,Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Noguchi
authors.affiliation: Department of Nursing,Graduate School of Medicine,Yokohama City University,Kanagawa,Japan.
authors.forename: Toshiko
authors.initials: T
authors.lastname: Matsushita
authors.affiliation: Section of Liaison Psychiatry and Palliative Medicine,Graduate School of Medical and Dental Sciences,Tokyo Medical and Dental University,Tokyo,Japan.
authors.forename: Eisuke
authors.initials: E
authors.lastname: Matsushima
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D010166:Palliative Care / Q000379:methods* / Q000523:psychology*; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011795:Surveys and Questionnaires; D014342:Truth Disclosure
keywords: Breaking bad news; End of life; Life expectancy; Palliative care; Truth disclosure