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Am Fam Physician. 2008;77(10):1458

Background: The diagnosis of breast cancer can be particularly distressing because of the many emotional, psychological, medical, and other implications of the disease. In addition to accepting the diagnosis, new patients with breast cancer are faced with complex choices about the available management strategies. These treatment decisions must often be made under time pressures, yet require a sophisticated understanding of the disease and its implications. How the patient is informed of a diagnosis is critical in disease management, but little is known about the most effective methods of communicating a new diagnosis of breast cancer to a patient.

The Study: Azu and colleagues surveyed nearly 700 women who had been treated for breast cancer between 1996 and 2006. They attempted to assess patient preferences and opinions about effective methods of communicating the diagnosis to patients.

Results: Surveys were returned by 236 (34 percent) of the patients. Almost all participants were white, and their average age was 60 years. One third reported that they were given their diagnosis by a woman and two thirds by a man. Ninety percent of respondents had no preference about the sex of the person who communicated the diagnosis to them. A clinical physician provided the diagnosis in 72 percent of cases, a radiologist in 19 percent, and a pathologist in 2 percent. Only 57 percent of respondents recalled being given the diagnosis in person, 40 percent were informed by telephone, and 2 percent by mail. Most respondents believed that the patient's personal physician should give the diagnosis; that it should be given in person; and that the patient should be accompanied by a significant support person when receiving the diagnosis. Patients also strongly endorsed the importance of the physician maintaining full attention and eye contact while giving the diagnosis.

Only 10 percent of respondents recalled knowing “a great deal” about breast cancer at the time of diagnosis. Allowing adequate time for communication was important or very important for 84 percent of respondents, and 59 percent remembered being so overwhelmed that they did not know what to ask during the disclosure. Asking the patient how much information they would like was important for 59 percent of respondents, but only 54 percent recalled being asked this at the time of diagnosis. Participants identified the desired information priorities as staging, prognosis, and survival.

In statistical analysis, the patients' most highly significant preferences were: being given the diagnosis in person by their physician; being accompanied by a support person; being asked how much information they desired; and being offered reading material about their disease.

Conclusion: The authors conclude that patients have specific preferences about how they would like to be informed of a breast cancer diagnosis. They stress the importance of the information being provided by the patient's personal physician, with enough time and the appropriate technique to allow the patient and her significant other(s) to receive the diagnosis and ask any questions.

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