Disclosing the cancer diagnosis. Procedures that influence patient hopefulness

BACKGROUND: Physicians view enhancing patient hopefulness as a critical aspect of cancer treatment, yet little is known about how the circumstances of the initial disclosure of a cancer diagnosis affects this important psychosocial variable. The authors examined the extent to which various forms of physician disclosure of a cancer diagnosis are seen by patients as more or less hopeful and as favorable or unfavorable. METHODS: Statements describing various circumstances of diagnostic disclosure were generated from interviews with 10 physicians and 10 patients with cancer. Fifty-seven statements were rated on two bipolar rating scales describing hopefulness and favorability by an additional 56 patients with recent onset of cancer. To determine if overall emotional adjustment to the illness affected these ratings, scores on the Mental Adjustment Scale were also obtained. RESULTS: Results revealed that patients had clear ideas about which procedures were most and least hopeful and favorable or unfavorable, that the ratings demonstrated clear factorial validity suggesting broad areas of diagnostic disclosure procedure where physicians may make efforts to enhance hope, and that ratings of hopefulness and favorability were related to overall emotional adjustment to the illness. CONCLUSIONS: There was consensus among patients that certain procedures enhanced hopefulness and certain procedures reduced it. Physicians would do well to attend carefully to this aspect of treatment and continually seek patient input concerning their preferences for the conduct of the treatment relationship.