WHEN THE DIAGNOSIS IS CANCER - PATIENT COMMUNICATION EXPERIENCES AND PREFERENCES

BACKGROUND. Discrepancies exist between reported experiences of patien ts when they have been given a diagnosis of cancer, published guidelin es for telling a diagnosis, and patterns of communication patients rat e as favorable, Several studies have identified what happened and what is important to cancer patients when told their diagnosis, but no stu dies have addressed subsequent communications concerning the implicati ons of the diagnosis and treatment choices, This study extended previo us research by investigating the experiences and preferences for commu nication about diagnosis, prognosis, and treatment of patients diagnos ed with breast cancer or melanoma. METHODS. A self-report questionnair e was designed for this study based on previous research and qualitati ve data generated from focus groups. Patients with breast canter or me lanoma answered questions about their experiences with communication a t the time of diagnosis and concerning prognosis, treatment and relate d issues. Comparisons were made between patient experiences, preferenc es and published guidelines. Differences between the experiences of br east cancer and melanoma patients were tested and the relationship bet ween communication and subsequent psychological adjustment to cancer w as assessed. RESULTS. Patient preferences for communication during dia gnostic consultation were not always consistent with published guideli nes. Type of cancer did not significantly affect patient preferences. Psychological adjustment was related to patient ratings of the quality of doctor discussion about treatment options, but not about the diagn osis of cancer and its implications. Patients who wanted more emotiona l support at the time of diagnosis subsequently experienced poorer psy chological adjustment. CONCLUSIONS. The differences in patient prefere nces show that a list of prescriptions for how to disclose a cancer di agnosis is too simplistic. Guidelines for clinicians should be derived from patient-based data rather than be limited only to clinical opini on. Guidelines concerning communication at the time of diagnosis also need to address discussions concerning the implications of the diagnos is and making treatment decisions. (C) 1996 American Cancer Society.