For more than a decade now, women were more likely to learn they had breast cancer in a telephone conversation with a doctor rather than an office visit, research from the University of Missouri (MU) School of Medicine found.
The trend favoring a cancer diagnosis delivered by phone dates to mid-2000s, and is evident both in the United States and elsewhere, the study reported. But despite being increasingly common, especially for non-advanced cancers, “little attention” has been paid “to the mode of communicating bad news to patients,” its authors said.
“When we analyzed the data, I was completely surprised to find such a clear trend,” Jane McElroy, PhD, professor of family and community medicine at the MU School of Medicine and the lead study author, said in a news release. “Historically, physicians have decided to use their best judgment when delivering a diagnosis, whether it’s in person or over the phone.”
The study, “Breaking Bad News of a Breast Cancer Diagnosis over the Telephone: An Emerging Trend,” was published in Supportive Care in Cancer.
In recent years, and depending on the physician, health care policy has evolved from a “doctor knows best” to a shared decision-making/patient-centered approach.
Available literature suggests patients prefer to receive their diagnosis in a private face-to-face consultation, where doctors speak clearly and in easy-to-understand terms while providing accurate information about the disease, its prognosis and treatment. Such discussions can include emotional support, allowing patients to freely express their feelings.
One study corroborated that higher patient satisfaction scores are associated with in-person discussions rather than in an over-the-phone disclosure (91% and 72%, respectively).
Although there are several protocols for a physician to deliver bad news, most assume an in-person conversation. Among them, there is also no consensus about the best way to do this: should it be a clinician’s decision, a matter of convenience, or should an institutional protocol be in place?
Moreover, “disparities between physician practices and patient expectations about the mode of bad news delivery may negatively impact breast cancer patient outcomes,” the team wrote.
Researchers sought to investigate how breast cancer diagnoses were shared with patients and how the chosen communication method was influenced by factors relevant to an individual patient.
They conducted online survey of 2,896 members of the Dr. Susan Love Research Foundation’s Army of Women. Participants were diagnosed between 1967 and 2017, and asked about how their doctor delivered the bad news plus what their support system during treatment was like. Scientists also inquired for breast cancer diagnosis details.
Results showed that prior to 2007, about 25 percent of patients received the news by telephone, and the rest told in person. Between 2008 and 2017, however, more than 50 percent of the women in this group learned of their diagnosis over the phone.
Data showed that most of the women told by phone had been diagnosed with in situ (non-invasive) breast cancer, and had post-diagnosis support from family, friends or professional groups.
Patients were significantly less likely to receive news of advanced, metastatic breast cancer by telephone, the study reported.
Still, “among all those who heard the news in person, a steady 40% learned of their breast cancer diagnosis with no one else present at their appointment,” the authors wrote.
Natalie Long, MD, an assistant professor of clinical family and community medicine at the MU School of Medicine, talked to McElroy about this study. Based on its findings, “we are now including additional training for first-year medical students to talk about situations and techniques for breaking bad news over the phone,” said Long. “The digital age has changed our perception of how we want to get news. I think younger patients just want to know news faster.”
But Long thinks a best practice would be for the physician to learn beforehand how the patient wishes to be informed, she said in the release. Doctors should also listen to the patient carefully, demonstrate empathy, confirm a support system exists, and develop a follow-up plan.
“Beyond identifying a clear pattern of more participants receiving their breast cancer diagnosis by telephone over time, we were not able to determine if this emerging communication pattern is being driven by participants’ preferences or by physicians’ preferences,” the study concludes. “This is an area in need of exploration.”
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