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| |  Wellbeing Of Chronically Ill Patients Depends On Information Provided WASHINGTON, DC -- July 28, 1998 -- Most patients with cancer and other serious illnesses want more information than their physicians offer, which frequently leads to unnecessary distress and feelings of hopelessness, an Australian research team reports. In one cancer program, for example, 75 percent of elderly patients said their doctors created undue worry by not providing them with sufficient information, while 40 percent of cancer patients in another study felt they were not fully informed about their diagnosis, prognosis, and treatment. "Health professionals believe that breaking bad news is an important task, but they feel inadequately trained to do it effectively," write Dr. Rob Sanson-Fisher and colleagues at the New South Wales Cancer Council Education Research Program, writing in a series of articles in the summer issue of Behavioral Medicine. Although some physicians believe that hearing bad news can be sufficiently upsetting to harm a patient's health, the evidence points in the opposite direction, Dr. Sanson-Fisher and his colleagues said. Patients may be seriously upset after learning a diagnosis of cancer, but most adjust well in the long term. "In fact, uncertainty is a major cause of emotional distress for patients," they write. "Relief from this uncertainty can, in itself, be therapeutic." Studies do show that the way patients are told bad news can exacerbate the distress they feel. Breaking bad news abruptly, over the telephone, or in the recovery room can prove especially distressing, they write. Many patients also react negatively when they feel physicians have withheld information or have not told them about other sources of help. Findings such as these have lead to medical school courses in how to break bad news and development of guidelines. Among the essential steps outlined by the Australian team: -- Give the patient the diagnosis honestly but not bluntly. While guidelines help establish the minimum level of care that patients can expect to receive, the challenge remains to design effective programs to convey bad news, the researchers said. Programs studied in 10 randomised controlled trials had little effect on psychological adjustment and inconsistent effects on patient knowledge and satisfaction with their care, they added. Another challenge is to persuade physicians to abandon old habits and adopt new techniques. "Given the difficulty in altering clinical behaviour, it is not reasonable to expect that widespread adoption will be achieved by simply producing best-practice guidelines," the researchers write.
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