Hearing the bad news of a cancer diagnosis: The Australian melanoma patient's perspective

Background: In the past, recommendations on how to break the bad news of a cancer diagnosis have been based on expert opinion. Recently, consensus-bas ed guidelines for medical practitioners have been developed. The objective of this work is to investigate patient preferences for communication practi ces and to identify any disparities between these guidelines, patient prefe rences and patient recollections of hearing their diagnosis. Patients and methods: A consecutive sample of 131 newly diagnosed melanoma patients were surveyed approximately 4 months after initial diagnosis to do cument their preferences and recollections of their communication experienc es. Results: Of the 'breaking bad news' recommendations investigated, patients did not strongly endorse the doctor helping tell others of the diagnosis or telling the patient about cancer support services. Very few patients expre ssed a preference for having another health professional present. One commu nication feature, the patient feeling confident about getting the best trea tment, was endorsed as 'very important' but does not feature in published g uidelines. The most notable disparities between guidelines and the reported experiences of patients related to perceived delays in receiving the diagn osis, and having adequate opportunity to ask their clinician questions. Conclusion: Current Australian recommendations on how to communicate a diag nosis of cancer were generally supported by the patients' expressed prefere nces, but several modifications are proposed. Implications: Suggestions are offered to help overcome the disparities iden tified between recommendations and patients' preferences when a diagnosis o f cancer is being communicated.