D.G. Mutch

Disclosing a Diagnosis of Cancer: Considerations Specific to Gynecologic Oncology Patients

OBJECTIVE: To characterize gynecologic oncology patients perceptions of the process of disclosure of a cancer diagnosis. METHODS: We surveyed 100 gynecologic oncology patients between December 2011 and September 2012. An 83-item tool based on three validated assessment tools evaluated patient-centered factors, physician behavior and communication skills, and environmental factors. Associations between patients satisfaction and these variables were analyzed using Wilcoxon rank-sum, Kruskal-Wallis, and Spearmans rho tests. Poisson regression was used to assess factors associated with patients satisfaction. RESULTS: Twenty-four percent of patients were notified of their diagnosis by phone, 60% in the physicians office, and 16% in the hospital. Disclosure was performed by an obstetrician–gynecologist (58%), gynecologic oncologist (26%), primary care physician (8%), or other (8%). Fifty-two percent of all patients were accompanied by a support person. Higher patient satisfaction scores were associated with face-to-face disclosure (mean score 91% compared with over the phone 72%, P=.02), a private setting (mean score 92% compared with impersonal setting 72%, P=.004), and duration of the encounter of greater than 10 minutes (mean score 94% compared with less than 10 minutes 79%, P<.001). Multivariate analysis confirmed that both physician communication skills (P<.001) and patient-centered factors (eg, perception of physician sensitivity and empathy, opportunities to ask questions and express emotion, and set the pace of conversation; P=.013) were associated with higher patient satisfaction. CONCLUSIONS: Effective physician communication skills and patient-centered factors resulted in higher patient satisfaction with the gynecologic cancer diagnosis disclosure experience. LEVEL OF EVIDENCE: II