David Brill
Telling a patient that her breast cancer has returned is traumatic for doctors too, according to a Singapore survey.
Nineteen out of 20 physicians interviewed said that breaking this news was harder than delivering the initial diagnosis of cancer, while half described this as the most stressful part of their job.
The study, designed to explore patient-doctor relationships, also revealed that trust between the two parties can be eroded when breast cancer recurs.
“Patients start asking themselves what’s gone wrong: ‘I trusted this doctor, why has it recurred?’” said Dr. Wee Siew Bock, a consultant breast surgeon at Mount Elizabeth Medical Centre, Singapore, who participated in the survey.
“Almost one in three doctors feels that when [recurrence] happens the patient will lose a bit of
trust in them. And I think that doctors in general see it more like an issue of failure – not because you have failed to treat the patient adequately but because you have not been able to meet the expectations of the patient, which is cancer-free survival after the first episode,” said Wee.
The patient arm of the survey comprised 68 Singapore residents who were assessed by questionnaire. The physician group – made up of nine breast cancer surgeons and 11 oncologists – was interviewed face-to-face.
The study also found that while 84 percent of patients said that they trusted their doctor to
recommend the best available treatment, 79 percent admitted to wishing that they had been given a more detailed explanation of why that treatment was chosen.
These findings underscore the need to empathize with patients when breaking the news of a recurrence, according to Wee, who presented the results at the recent inaugural Breast Cancer Survivors’ Conference.
“I think that being able to make the patient understand her condition better means that you
are likely to get a more engaged patient when it comes to treatment. And a patient who is more
engaged is likely to be more positive and generally able to handle and cope with their illness a lot
better,” he said.
Wee also advised doctors to consider the importance of a patient’s support network, and to try
to encourage family members or friends to accompany the patient for consultations.
“It’s exceptionally traumatic if the patient just breaks down and falls apart in front of you and there’s nobody to support them, because at the end of the day you’re still the doctor … you have been delivering good news all along, now you tell her the bad news. I don’t think she will turn to you for support,” he concluded.
The survey was jointly commissioned by the Breast Cancer Foundation and AstraZeneca Oncology, and was conducted by German market research company, GfK.
Tips for communicating bad news to patients
Dr. Wee Siew Bock, consultant breast surgeon at Mount Elizabeth Medical Centre, Singapore, offers tips on breaking bad news to patients.
1. Be patient with your patients: “The most important thing is to sit down and listen … giving the patient time to express her fears and concerns will actually go a long way in helping you communicate better.”
2. Speak the same language: “One of the things that we must try to do is use more lay terms. Sometimes even using the dialects or languages that the patient is conversant in helps a lot.”
3. Be creative: “Sometimes I feel that using little analogies is very useful. It helps the patient … grasp the situation a bit better.”
4. Wait for the right moment: “It might be easier to get the message across with another relative of the patient around. Usually this happens with older women: if you have the younger relatives around, they can explain it better.”
5. Do your research: “I find it may be useful to just review the patient’s medical history: how she was when you first diagnosed her a few years ago, who came with her, how she coped – just to try to refresh how it was that she handled that situation. That gives you an additional dimension to how to break this bad news to that patient.”
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