Investigating communication in cancer consultations: what can be learned from doctor and patient accounts of their experience? (bad news disclosure)

Abstract

Authors:

1. L. Furber PhD, BSc (HONS), RN, Dip HE Post Doc Senior Nurse Researcher^1,*,
2. K. Cox PhD, BSc, RN, Onc Cert, Dip HE, DN, PGCAP Professor of Cancer and Palliative Care²,
3. R. Murphy PhD, BSc Director of Post Graduate Research³,
4. W. Steward MBCh.B, PhD, FRCP Head of Department⁴

This study investigated how doctors and patients diagnosed with advanced incurable cancer experienced the disclosure of bad news. The intention was to gain contrasting perspectives of the processes involved in oncology consultations. Sixteen doctors and 16 patients from a cancer centre in the UK participated in the study. A series of consultations were observed and audio recorded, and the perspectives of doctors, patients and relatives were investigated through semi-structured interviews. Participants were invited to describe how they experienced and felt about the disclosure of information over a period of time following a specific consultation. Analysis was based on a constant comparative method. This research suggests that patients control what they do or do not do with information to meet their own needs and objectives, but doctors do not necessarily appreciate this. Doctors do not always prepare patients for what is happening to them in an active open awareness context, and this can be stressful for some patients. The results indicate that communication is not just about one person making decisions. They also indicate that in many cases more success could be gained from finding out how patients prefer to manage and control the exchange of bad news, at different points, through their care pathway.