Misunderstanding in cancer patients: Why shoot the messenger?

Aim: We aimed to document the prevalence of misunderstanding in cancer pati ents and investigate whether patient denial is related to misunderstanding. Patients and methods. Two hundred forty-four adult cancer outpatients recei ving treatment completed a survey assessing levels of understanding and den ial. Doctors provided the facts against which patient responses were compar ed. Multiple logistic regression analyses determined the predictors of mis understanding. Results: Most patients understood the extent of their disease (71%, 95% CI: 65%-77%) and goal of treatment (60%, 95% CI: 54%-67%). Few correctly estim ated the likelihood of treatment achieving cure (18%, 95% CI: 13%-23%), pro longation of life (13%, 95% CI: 8%-17%) and palliation (18%, 95% CI: 10%-27 %). Patient denial predicted misunderstanding of the probability that treat ment would cure disease when controlling for other patient and disease vari ables (OR = 2.20, 95% CI: 0.99-4.88, P = 0.05). Patient ratings of the clar ity of information received were also predictive of patient understanding. Conclusions. Patient denial appears to produce misunderstanding, however, d octors' ability to communicate effectively is also implicated. The challeng e that oncologists face is how to communicate information in a manner which is both responsive to patients' emotional status and sufficiently informat ive to allow informed decision-making to take place.