Informing patients of cancer diagnosis is an ethical, sensitive and controversial issue. – Dr Marlain Mubarak, Consultant Obstetrician & Gynecology and Head of British Society Accredited Endometriosis Center, Canadian Specialist Hospital, Dubai
Cancer diagnosis; How much should we disclose to patients.
In the United Kingdom the cancer teams are provided with special training to allow the medical team to approach this diagnosis in a sensitive way.
Two different attitudes had been noted in our society as some doctors avoid disclosing cancer diagnosis to patient, whereas others emphasize practice of honest communication and patient’s right to be informed of their diagnosis. The group who support disclosure of the diagnosis provide their reasons as it helps a patient to get mentally, physically, emotionally and cognitively prepared about his/her terminal illness.
On the other hand, the people who stress no revelation of the diagnosis to patients claim that it will bring a psychological trauma to the patient. Besides, some cultures assume this ailment as a social stigma.
Additionally, it is also believed that informing patients of cancer diagnosis may bring fear of death in the patient or cause impairment of coping for the patient. In my opinion, it is one of the patient’s fundamental rights to be involved in their diagnosis, investigations and treatment choices.
From my personnel experience as the Head of Gynecology Oncology in the United Kingdom, patients are usually suspicious of their diagnosis and express a relief when they are given the full details and extent of their disease.. If they are not informed clearly, they stay suspicious and the risk is that we increase their anxiety and as well risk that they don’t comply with the treatment which could be life saving for them.
The number of cancer diagnosis is on the rise and 1 out of 3 people will develop cancer in their life time. Prevention is better than cure and as well early diagnosis and treatment have a positive outcome. We have several screening programs for cancer and pre-cancer conditions.
That includes Breast, bowel and cervical cancer. The diagnosis of pre-cancer does not means a person will develop cancer. So its important to be clear about information we provide to patients and providing reassurance and emphasizing on complying with treatment and follow up. In some cases we use the term of pre-cancer, but from my personnel experience in PAP smear and Colposcopy as part of cervical cancer screening, in most women we didn’t use the term of pre- cancer but emphasized on importance of treatment and follow up to prevent cancer from developing.
The outcome and survival is related to the organ involved, type of cancer and the grade of the cancer. So irrelevant of the grade, it is important to be accurate with describing the cancer, giving patients accurate information about how aggressive the disclosure of the cancer diagnosis could be broken into stages depending on individual patients.
It is argued that disclosure of cancer diagnosis can worsen patient’s hope and coping. Cancer specialist with the help of a team of experts is trained to provide physical and psychological support to cancer patients. In the UK this involves a cancer nurse specialist.
Cancer diagnosis can help some patients to adopt a more positive attitude toward life, healthy living and exercising and as well a focus on enjoying the moment and as a result can improve the quality of life and relationships with family and friends.
Patients coping and hope are very much individual. More people are surviving cancer than ever before. Especially childhood cancers as many are cancer free and are able of having their own children’s. Being positive and giving patients accurate diagnosis and supporting them increase the cancer treatment compliance and as well.
It is very important to have a positive attitude to achieve positive outcome in this controversial run of life. If we won’t disclose cancer diagnosis to the patient, we will be violating patient’s right, which is morally and ethically incorrect and unacceptable and can give harm to the patient’s life. Also it deprives the patient from planning their life and future as many cancer patients change their attitude to life and take advantage of enjoying the now and the moment.