The delivery of a diagnosis of breast cancer to a patient elicits a strong emotional response from the patient, and similarly, evokes an emotional response from the surgeon as well. The ability to deliver bad news in a way that helps improve communication and strengthen the patient–doctor relationship is a skill not often taught, although it is frequently required. Most studies have examined oncologists, and one found that 60% broke bad news to patients from 5 to 20 times per month. Fourteen percent delivered bad news more than 20 times a month. Less than 10% of those surveyed had any formal training in breaking bad news, and only 32% had any shadowing experience in watching others deliver diagnoses.1 An American Society of Clinical Oncology survey revealed that most participants cited "traumatic experience" as the most common source of learning communication on difficult topics.2
Women with breast cancer, in particular, have high levels of unmet needs for health information, difficulties accessing information, and dissatisfaction with information gleaned from health care providers.3-6 Thus, the importance of good communication in this group cannot be stressed enough. This chapter seeks to present a brief overview of delivering a breast cancer diagnosis, including the importance of the topic, barriers to communication, and strategies for the delivery of the diagnosis.
The delivery of a diagnosis of breast cancer falls into the category of "bad news." This is basically defined as "any information which adversely and seriously affects an individual's view of her future."7 This is very dependent on the patient's subjective feelings and the gap between the patient's expectations of the future and the medical reality. Thus, it is key to have an appreciation for the patient's expectations and her understanding of the medical situation while delivering the diagnosis.
The delivery of the diagnosis of breast cancer involves complex communication, including a verbal component as well as the recognition and response to emotion, the involvement of the patient in the decision-making process, provision of support, and the preservation of hope.1 Effective delivery of the diagnosis can affect a patient's compliance with treatment, better understanding of disease process, lessen stress, and improve patient satisfaction.8 The way in which bad news is broken "influences the patient's subsequent psychosocial adjustment."9 It has also been noted that disclosure of bad news is not universally harmful to patients but that failure of good communication may be.10
There is a level of autonomy and disclosure in medical decision-making now that was not present previously, as patients desire information about their illness. One survey revealed that 96% of participants wanted to be given their diagnosis of cancer and 85% wanted a realistic prognosis.11 This is particularly true for breast cancer patients as well. A study by Lobb and colleagues found that 83% of women wanted as much information about their disease as possible,3 and a similar study noted ...