Strategies of information disclosure to Chinese cancer patients in an Asian community

Abstract

There is little information available on strategies of information disclosure used by doctors in the care of patients with cancer. This report focuses on the style of disclosure used by doctors when giving diagnostic and prognostic information to patients with cancer. Among 46% of 133 surgeons and radiotherapists interviewed, disclosure of diagnosis involved a sudden approach (information given outright at one sitting). Less commonly used (19%) was a gradual disclosure style. Of the remainder who disclosed, more than half did so through the family or left it to the family to tell the patient. Doctors' specialty and patients' requests for prognostic information dictated disclosure style most frequently. Single people were more likely to have information disclosed to their families than were married people. While anecdotal accounts indicate negative reactions on the part of patients are a major reason for withholding such information, different disclosure style had little effect on doctors' reports of patient reactions to the bad news. Doctors perceived 25% of patients appeared to react 'with depression' but the remaining 75% appeared 'calm'. These results suggest patients are more likely to be told bad news suddenly, and that doctors do not perceive that this impacts too negatively on patients. The high levels of reported preference for information about cancer in Hong Kong (Fielding and Hung, 1996) conflict with actual prevalence patterns. It seems that commonly cited anecdotal reasons for withholding information from cancer patients in Hong Kong are not sustained by the data produced in these studies.