Memo to Doctors: Spit Out the Bad News

Doctors, don’t be afraid to deliver bad news.

Telling cancer patients the truth about their chances of survival does not harm a physician’s relationship with those people. It could even make it better, according to a new study.

“We hope this information will reassure clinicians about any negative impacts of these discussions on their relationships with patients,” said study lead author Joshua Fenton.

“Discussing prognosis doesn’t undermine trust — and informing patients may have large benefits in terms of future quality of life,” added Fenton. He is a professor of family and community medicine at the University of California, Davis.

The study included 238 adults with advanced cancer. The patients received bad news about their disease progression from oncologists in New York state and California.

Interviews with the patients showed that hearing the poor prognosis did not harm their relationship with their oncologist one week after receiving the news. And it actually improved the relationship three months later, the researchers said.

The findings contradict two previous studies that concluded that such discussions can increase patients’ depression and disrupt their relationship with their doctor.

Fenton noted that many oncologists spend little time talking with patients about prognosis or end-of-life options such as palliative care and hospice. That can lead to more hospital care, lower quality of life and even shorter survival, plus more difficulties for caregivers.

“Prognosis discussions don’t happen early and often. As a result, it’s been clearly documented that many patients often completely misunderstand their prognosis, so treatment decisions made near the end of life might not be totally aligned with the patients’ and caregivers’ priorities,” Fenton said in a university news release.

The study was published Nov. 17 in the Journal of Clinical Oncology.

More information

The U.S. National Cancer Institute has more on communication in cancer care.