Posted on Tuesday 4th February 2014
Hilary Brown, Health Services Management Centre
Today, tens of thousands of people worldwide will be diagnosed with cancer of one type or another. In the UK alone, over 900 people are diagnosed with cancer on any one day (Cancer Research UK).
We have become much better at raising awareness, diagnosing and treating the disease and survival has doubled in the last 40 years - all news worth celebrating. But have we become better at helping people through their illness as they deal with the fear, the uncertainty, the pain, the anxiety and the loneliness, not to mention the confusion of treatment options and procedures and the exhaustion of navigating the system?
Being given a confirmed diagnosis by an oncologist at an outpatient appointment when you already have a suspicion of the disease is problematic enough when it comes to understanding and retaining the information. Previous research does not make happy reading - Ley (1988) suggests that half of all patients forget most of the information given to them within minutes of a consultation, Kessels (2003) that all patients forget between 40-80% of medical information, and Anderson et al (1979) suggest that almost half of information provided is remembered incorrectly. Research also shows discrepancies in what information patients and doctors think has been provided and discussed in a consultation (Meropol et al, 2003). This would suggest that of those 900 plus people receiving a diagnosis of cancer today, many will have difficulties absorbing, processing and understanding the information.
And what about those older people who are given a diagnosis when they are either admitted to hospital as an emergency or are already in hospital receiving care for a seemingly unrelated issue, when they are likely to already be feeling fearful and disorientated? I have been on the sharp end of this recently with an elderly close relative and it’s got me thinking more about how older people receive the news of a cancer diagnosis and how doctors and nurses communicate with them about their prognosis and treatment.
The results of the 2013 National Cancer Patient Experience Survey are considered a success story for the NHS, with support for patients and information on treatment and care reported as improving, as measured by patients themselves. This is a positive development but the results of the survey may not show the real picture for those older patients who do not enter a ‘cancer pathway’ by the standard route. If an older person is admitted to a geriatric ward or a stroke ward, how likely are the doctors and nurses looking after them to have had any specialist communication training for dealing with cancer patients and how available are cancer specialist staff to these patients? We know from the survey report that the over 75s are less likely to have specialist nurse support for example.
The number of new cases of cancer will continue to increase, the population will continue to age, and with this we will also see associated increases in the number of patients admitted to hospital with forms of dementia. Should we not therefore be thinking more about the care of older people who are diagnosed with cancer as a result of their admission for something else? How are they informed of their diagnosis, who checks that they understand the information given to them and who will support them in their hours of need?
Anderson, J.L., Dodman, S., Kopelan, M. and Fleming, A. (1979) Patient information recall in a rheumatology clinic. Rheumatol Rehabil 1979:18: 245-255
Kessels, R. (2003) Patients’ memory for medical information. J. R. Soc. 2003:96: 219-222
Ley, P. (1988) Communicating with patients. Improving communications, satisfaction and compliance. London: Groom Helm
Meropol, N.J. (2003) Perception of patients and physicians regarding Phase 1 cancer clinical trials: implications for physician- patient communication. Journal of Clinical Oncology 21, 2589-2596