Disclosing the cancer diagnosis: Procedures that influence patient hopefulness
Aaron N. Sardell (1991)
Patients receiving a cancer diagnosis often experience a profound sense of hopelessness. Recent findings suggest that psychosocial factors, including a patient's level of hopefulness, can affect the course of the illness and subsequent recovery. A physician who presents the patient with a cancer diagnosis is in a unique position to affect the patient's level of hopefulness. In this study, physicians (10) and cancer patients (10) were interviewed in order to compile a collection of statements describing procedures and arrangements physicians use to initially disclose diagnoses to cancer patients. Fifty-six cancer patients were asked to retrospectively rate each statement indicating the degree of hopefulness that each method would have generated at the time of the patient's diagnosis. Results revealed a consensus among patients that certain procedures used to disclose diagnoses increase patient hopefulness. These procedures include: the presentation of all medical information, statements of encouragement by the physician, affirmations of emotional support from the physician and significant others, opportunities for patient participation in treatment, and arrangements that maintain patient individuality and privacy. Procedures judged as reducing patient hopefulness include expressions by the physician indicating negative prognosis, physician attempts to limit the disclosure of medical information, and arrangements that emphasize patient impersonality. Significant differences were found between the patient's type of cancer, psychological response to the diagnosis and specific procedures designed to increase patient hope. It is recommended that physicians who disclose cancer diagnoses should maintain a position of respect for and curiosity about the patient's individual style of coping. Additionally, physicians should, when possible, fully disclose medical information and encourage patient participation with an emphasis on collaborative attempts to "fight" the cancer. Implications for future research are discussed.