Reluctance to disclose difficult diagnoses: A narrative review comparing communication by psychiatrists and oncologists

ArticleinSupportive Care Cancer 15(7):819-28 · August 2007with20 Reads
DOI: 10.1007/s00520-007-0226-y · Source: PubMed
Abstract
National guidance in most medical specialties supports the full and open disclosure of diagnoses to patients. Surveys show that most patients want to know their diagnosis, whether it is medical or psychiatric, and a substantial proportion want to know detailed prognostic information. In the past, oncologists have been criticised for failing to reveal a diagnosis of cancer to patients in a sensitive and timely manner. Over the last 30 years, there is evidence that this practice has improved. Yet, clinicians still have difficulty when the diagnosis is not certain, when the prognosis is unfavourable, and when relatives request "not to tell." All of these influences are present in mental health settings. Psychiatrists and general practitioners may be equally reluctant to reveal difficult diagnoses and prognoses of conditions such as schizophrenia and dementia. The reluctance to reveal a difficult diagnosis may be a routine, but little acknowledged the aspect of medical care that should be incorporated into undergraduate and postgraduate education and openly discussed during peer group supervision.
    • "Findings from this research contribute to the limited body of knowledge in this area, provide important insights for clinical practice and inform the development of psychiatry training programmes targeting clinical communication skills. Consistent with previous findings (Fisher, 2000; Hallett et al., 2013; Mitchell, 2007), our results confirm that most patients prefer a diagnosis, rather than living with the uncertainty. Diagnosis provided a sense of relief for many, helping to understand experiences and behaviours. "
    [Show abstract] [Hide abstract] ABSTRACT: Transparent diagnostic communication is considered best practice for clinicians. However, while patients expect to receive a schizophrenia diagnosis from their psychiatrist, research suggests mental health clinicians are often reluctant to provide this information to patients. This study examines the perceptions of people with schizophrenia surrounding the communication of this diagnosis. A generic qualitative methodological approach was used. A total of 14 patients with schizophrenia were recruited through community mental health services (n = 10) and the Australia Schizophrenia Research Bank (ASRB; n = 4) in New South Wales (NSW), Australia. Semi-structured interviews were used to explore the experiences and perceptions of people with schizophrenia about the way a schizophrenia diagnosis was communicated by mental health clinicians. Interviews were recorded, transcribed, codes generated and thematic analysis undertaken aided by NVivo. The majority of participants felt it was beneficial to receive a diagnosis despite acknowledging the distress this information sometimes caused, with many reporting this knowledge gave a sense of relief. It helped to understand their experiences and behaviours, improved their trust in the psychiatric system and increased treatment adherence. However, many reported difficulty in obtaining information about their condition, its treatment and prognosis, and expressed dissatisfaction with the way a diagnosis of schizophrenia was communicated. Insight into the perceptions and experiences of patients with schizophrenia about how a diagnosis of schizophrenia is communicated is a key outcome of this research. This knowledge will inform the development of future training programmes for mental health clinicians, and influence the clinical practice of health professionals treating patients with schizophrenia. © The Author(s) 2015.
    Full-text · Article · Apr 2015
    • "All have been narrative literature reviews (Atkinson, 1989; Cleary et al., 2009; Lequesne & Hersh, 2004; Mitchell, 2007; Rose & Thornicroft, 2010) that lacked systematic synthesis. In addition, some focused on communication of news for subtypes of mental health issues (Atkinson, 1989; Lequesne & Hersh, 2004) or concentrated chiefly on making comparisons with the oncology field (Mitchell, 2007). Given this growing evidence base, a systematic synthesis of literature, which includes a broad spectrum of MHD, has been called for in the literature (Cleary et al., 2009). "
    [Show abstract] [Hide abstract] ABSTRACT: Abstract Background: There is limited understanding of the mechanisms used to effectively communicate with service-users about their mental health diagnoses. Aims: To conduct a systematic synthesis of studies that present data on the communication of a psychiatric diagnosis. Methods: Comprehensive database and manual searches were conducted resulting in the inclusion of 30 quantitative and qualitative papers. Results: The majority of studies were descriptive. The rate of service-users being informed of their diagnosis has increased over the past decade. Consumer communication preferences were not always satisfactorily addressed in practice. Individual characteristics of service-users and clinicians influenced whether a diagnostic discussion took place. Results from intervention studies aimed at facilitating diagnostic communication reported significant improvements in service-user satisfaction and mood and clinician communication skills. Conclusions: This review highlights a gap in the system of communication between clinicians and service-users. To assist clinicians to talk effectively with individuals about their mental health, communication protocols and training need to be further developed and assessed. Such developments would benefit from well-designed randomised controlled trial protocols, should incorporate service-users' preferences and address stigma-related concerns.
    Full-text · Article · Oct 2014
    • "In one study, only one-third of psychiatrists reported that they explicitly stated a diagnosis of schizophrenia, the others preferring instead to use terms such as 'psychosis' or 'breakdown' (Clafferty, McCabe, & Brown, 2001). Factors such as diagnostic uncertainty, pessimism regarding prognosis, concern about stigma and the illness itself interfering with patient ability to comprehend the information are all cited as reasons for not giving a diagnosis of schizophrenia (Bracken & Thomas, 2000; Mitchell, 2007; Seeman, 2010). In a recent study by our group (Outram et al., 2014), just over half the clinicians (9/16) said they agreed with providing patients with a named diagnosis of schizophrenia ; however, most gave multiple reasons for not doing so in practice, and some did not believe it appropriate to give a diagnosis at all. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Despite widespread acceptance of the principle that patients should be informed about their diagnosis, many clinicians are reluctant to provide a diagnosis of schizophrenia. This study examines family caregivers' experiences of the communication of a schizophrenia diagnosis and related information. Methods: A generic qualitative methodological approach was used. In all, 13 family caregivers were recruited in regional New South Wales, Australia. Semi-structured interviews were used to explore their experiences and perceptions of discussing the diagnosis, prognosis and treatment of schizophrenia with mental health professionals. Interviews were recorded, transcribed, codes generated and thematic analysis undertaken. Results: Family caregivers described long and difficult pathways to being given a diagnosis, haphazard means of finding out the diagnosis, high unmet needs for information, exclusion from the medical care process and problematic communication and general interactions with mental health clinicians. Caregivers were unanimous about the importance of receiving a timely diagnosis, for them and their relative with schizophrenia. Conclusion: Family caregivers are an integral part of the mental health-care system, and they should be included early in discussions of diagnosis and treatment of a person with schizophrenia. Their perspectives on communicating a diagnosis of schizophrenia provide important information for communication skills training of psychiatrists and other mental health professionals.
    Full-text · Article · May 2014
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