Wellbeing Of Chronically Ill Patients Depends On
Information Provided
WASHINGTON, DC -- July 28, 1998 -- Most patients with cancer and other
serious illnesses want more information than their physicians offer,
which frequently leads to unnecessary distress and feelings of
hopelessness, an Australian research team reports.
In one cancer program, for example, 75 percent of elderly patients said
their doctors created undue worry by not providing them with sufficient
information, while 40 percent of cancer patients in another study felt
they were not fully informed about their diagnosis, prognosis, and
treatment.
"Health professionals believe that breaking bad news is an important
task, but they feel inadequately trained to do it effectively," write
Dr. Rob Sanson-Fisher and colleagues at the New South Wales Cancer
Council Education Research Program, writing in a series of articles in
the summer issue of Behavioral Medicine.
Although some physicians believe that hearing bad news can be
sufficiently upsetting to harm a patient's health, the evidence points
in the opposite direction, Dr. Sanson-Fisher and his colleagues said.
Patients may be seriously upset after learning a diagnosis of cancer,
but most adjust well in the long term. "In fact, uncertainty is a major
cause of emotional distress for patients," they write. "Relief from this
uncertainty can, in itself, be therapeutic."
Studies do show that the way patients are told bad news can exacerbate
the distress they feel. Breaking bad news abruptly, over the telephone,
or in the recovery room can prove especially distressing, they write.
Many patients also react negatively when they feel physicians have
withheld information or have not told them about other sources of help.
Findings such as these have lead to medical school courses in how to
break bad news and development of guidelines.
Among the essential steps outlined by the Australian team:
-- Give the patient the diagnosis honestly but not bluntly.
-- Encourage patients to express their feelings.
-- Offer a broad but realistic time frame for the prognosis.
-- Discuss the treatment options. Avoid the notion that nothing more
can be done.
-- Arrange another time to review the situation.
-- Provide information about support services.
While guidelines help establish the minimum level of care that patients
can expect to receive, the challenge remains to design effective
programs to convey bad news, the researchers said. Programs studied in
10 randomised controlled trials had little effect on psychological
adjustment and inconsistent effects on patient knowledge and
satisfaction with their care, they added.
Another challenge is to persuade physicians to abandon old habits and
adopt new techniques.
"Given the difficulty in altering clinical behaviour, it is not
reasonable to expect that widespread adoption will be achieved by simply
producing best-practice guidelines," the researchers write.
--
Judith Richards, London, Ontario, Canada
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