Cancer patient expectations of and communication with oncologists and oncology nurses: the experience of an integrated oncology and palliative care service

The purpose of this study was to evaluate ambulatory cancer patients' knowl edge of their diagnosis and stage, their expectations of medical and nursin g staff, and issues related to communication with the professional staff. A structured interview was conducted with each of 103 consecutive cancer pat ients attending the Oncology Day Hospital of the Shaare Zedek Medical Cente r. There were 77 women and 26 men, and their median age was 56 (18-86) year s. Their religious status was elicited: 48% described themselves as religio us, 25% as traditional, and 27% as secular. According to their physicians, 41 were in remission, 11 had stable disease, 47 had progressive disease and in 4 the disease status was unknown. Patients tended to underestimate the status of their disease: among those with progressive disease, 36% stated t hat their disease was stable or in remission. Overwhelmingly. patients expe cted that their oncologists should be patient and skilled in diagnostic pro cedures (98%), tactful, considerate and therapeutically skilled (90-95%), a nd skilled in the management of pain and the psychosocial consequences of c ancer (75-85%). When there is bad news to be transmitted, 92% of patients i ndicated that they would want disclosure, while 6% indicated that they woul d want the news withheld from them but passed on to their family members. M ost patients were very satisfied with the clarity of the information they r eceived about their disease (85%) and the sensitivity with which it was tra nsmitted (90%). Although 88% of patients reported that they relied on their oncologist for therapeutic decision making, 45% indicated that they had so ught a second opinion and 32% reported seeking the opinion of a rabbinical medical broker. Almost all, 97%, of patients indicated that they felt comfo rtable seeking advice from their oncologist, and the oncologist was the sta ff member most often sought out for both information (69%) and support (66% ). The data indicate high patient expectations of nursing and medical oncol ogy staff members' skills and behaviors. Despite expressing a high level of satisfaction, a substantial percentage of patients had an inaccurate under standing of their disease status.