Should Doctors Break News To Patients By Telephone?

[naomi24]

A friend had an operation for bowel cancer. Unfortunately the cancer had spread to her lymph nodes and now ‘something’ has been found on her liver. She received a call late last week asking her to attend an appointment with the consultant early this week - but she is dreading it because she fears the worst. In circumstances like this, rather than give patients days or weeks of worry, would it be kinder to tell them the results of tests, whether good or bad, immediately over the phone?

I would rather know straightaway. What do you think?

[naomi24]

Thanks sqad.

[LadyCG]

Has the consultant actually got results to discuss with the patient? Has the "thing" on the liver actually been biopsies?

The Consultant might be wanting to meet to discuss treatment options, obtain consent, etc.

[ummmm]

Pixie - I find it easier talking on the phone than face to face. For some reason I'm much more relaxed so don't forget to ask important questions.

[LadyCG]

Biopsied

[pixie374]

Fair enough, ummm. They should be giving numbers and sites so you can do that too.
If my friend had been told over the phone, her "support" would have been her 3 under 10s over the weekend.

[joeski53]

I understand an immediate response by phone call, but for me it wouldnt do, My reasons are simple
1/ I would have lots of questions to ask
2/ They would answer them over the phone there wouldnt be enough time
3/ I would want to know what I could do there and then to combat/help
4/ Face to face answers I would want.
5/ A phone for me just is not the same to get news like this.

[tamborine]

I know am gonna die & dont want to know when. Some peeps believe fortune tellers or dreams even. Unless requested dont tell.

[naomi24]

No, there has been no biopsy, LG. She had an MRI scan a couple of weeks ago, then they rang early last week and asked her to come for a PET scan the following day, and on Friday they called to tell her 'something' has been found on her liver and asked her to attend an appointment tomorrow.

[naomi24]

Sorry, that^ to LCG.

[joeski53]

It may something other than what she thinks it is? Pet scans show other things not necessarily what you think it is.

[eve1974]

barsel //n my lifetime I've had 2 cancer scares and each time, I've been happy not to get the results and wait as long as possible for them//

I see your point - however in Naomi's friends case - as in my husbands - they are / were already fighting cancer. Already diagnosed so it's news about where it may have spread / progressed to. When one is already fighting cancer always at the back of the mind is ..."is this the result that will say it's terminal"

A cancer scare is indeed scary - a cancer diagnosis scarier still in our experience.

[eve1974]

Naomi all you can do is reassure your friend that you're thinking of her whilst she's worrying -

[LadyCG]

It's possible that the Consultant has discussed her case at the Colorectal MDT in the meantime and he wants to convey not only the findings of her investigations but the outcome of the MDT discussion. There would need to be an MDT consensus that the liver "thing" actually represented metastatic disease or warranted biopsy for further characterisation.

[Peter Pedant]

from the answers - it is obvious some do and some dont

If the index case has had a PET scan and they wish to see her face to face then it is obvious that it is something else than 'all clear'

JoeSki is correct in saying the PET scan scores in all sorts of conditions BUT if you are looking for secondaries and there is uptake then it is likely the uptake is from secondaries.
( pretty useless for follow up, but good to tell the extent of spread once you know it is there)

[Baldric]

Tell me ASAP, then I can deal with it, one way or another.

[anneasquith]

A friend had a call from a consultant last week following a scan. He asked if she had someone with her, in answer to her yes reply, he told her cancer was found ‘ around the liver area’ His reasoning for telling her at home was. When she came for her appointment the initial shock will have passed , as would crying and distress. He wanted the appointment to discuss the findings of the scan and the treatment, and her future .

[rowanwitch]

When Dave was going through investigations we agreed in advance that we would accept results over the phone with a follow up appointment to discuss options. This gave me a chance to find out what was available in advance and prep Dave for the consent process. He always focused on the worst case when consented so having the figures to hand was very useful. However the Oncology team all knew me from my roles in bed management and cancer services. Most patients had an early walk in appointment though. It was rare for results to be given by telephone but sometimes they would be faxed to a GP if the patient preferred

[eve1974]

Naomi - how did it go for your friend today?

[naomi24]

Thanks for asking, Eve. They found several small cancers which have spread from the bowel, one that isn’t on the surface. They said they will operate but if they can’t get to that particular one they will burn it out. Personally, I don’t hold out expectation of very many years ahead for her but this will hopefully prolong her life to some degree. The Consultant said these operations are carried out multiple times on some patients, so fingers crossed she will be one of them.

How difficult would it have been for them to phone her and say something like, ‘We have found cancers but we can operate. Please attend an appointment’? All that stress over days could have been avoided. She really thought they were going to say there is no hope - and so did I.

Thanks for all your answers everyone.

[eve1974]

Glad it’s operable ... and I agree... the best thing in her case wld have been to give her a few of the details ... (ie it’s operable for the moment). and say “yCome in on Tuesday and we will discuss the details”

Shes been on my mind because we too got the Friday call ... and the waiting till the tues was so hard.