Disclosing a diagnosis of cancer: Where and how does it occur?

Purpose: While disclosing a cancer diagnosis to a patient is common practice, how it is disclosed and the impact it has on the patient are poorly understood. We examined how cancer diagnoses were first given to patients and the impact of different aspects of disclosure on patient satisfaction. Patients and Methods: We provided a self-administered questionnaire to a total of 460 oncology patients of the National Cancer Institute (NCI) being treated at the National Institutes of Health (NIH) Clinical Center in Bethesda, MD. Results: Of the 437 patients who completed the survey, 54% were told their diagnosis in-person in the physician's office, 18% by phone, and 28% in the hospital. Forty-four percent of patients reported discussions of 10 minutes or fewer, 53% reported discussions lasting longer than 10 minutes, and 5% could not remember. Treatment options were not discussed for 31% of those who could clearly remember. Higher mean satisfaction scores were associated with diagnoses revealed in person rather than over the phone (68.2 ± 1.6 v 47.2 ± 3.7), diagnoses revealed in a personal setting rather than an impersonal setting (68.9 ± 1.6 v 55.7 ± 2.8), discussions lasting longer than 10 minutes rather than fewer than 10 minutes (73.5 ± 1.9 v 54.1 ± 2.4), and inclusion of treatment options rather than exclusion (72.0 ± 1.9 v 50.7 ± 3.2; P <.001 for each aspect). Conclusion: Physicians should disclose a cancer diagnosis in a personal setting, discussing the diagnosis and treatment options for a substantial period of time whenever possible.