A Maltese perspective on breaking bad news in cancer : an assessment of patients’ preferences

Abstract

Background It is unclear among Maltese physicians whether cancer patients wish to know their diagnosis or not, and if they do, to what extent they wish to be informed. Aims and Objectives To assess Maltese patients’ preferences for receiving a cancer diagnosis and being involved in the decision-making process, and then compare with results from similar international studies. Methods Two hundred fifty-two Maltese adult patients with a diagnosis of malignancy of more than one month were invited to complete two standardised tools: the Measure of Patients’ Perspective (MPP), a thirty-two item tool assessing patient’s preferences for being given news about their cancer, and the two-item Control Preferences Scale (CPS) which documents patients’ desire to be involved in the decision-making process. These were completed by one hundred ninety-nine patients who rated characteristics of the information, context and support given, on a scale from one to five for the MPP, and levels of patient involvement in treatment decisions, from A to E, for the CPS. Demographic and medical data were also collected. T-tests, one-way ANOVA and post-hoc analysis were used. Results Maltese patients rated the ‘content’ subscale – what and how much information is given (mean 4.17, CI 4.08-4.25, SD 0.59) as significantly more important (p=0.047) than ‘support’ – offering comfort and support (mean 3.73, CI 3.63-3.83, SD 0.68) and ‘facilitation’ – where and when the information is given (mean 3.86, CI 3.76-3.96, SD 0.68). The MPP item ‘Having the doctor tell me the news directly’ was given a mean rating of 3.91 (SD 0.97). With respect to the CPS, although there is a trend away from a passive role on the part of the patient, towards a collaborative role, and to a lesser extent, an active role in treatment decisions, patients still exhibit a paternalistic attitude towards their physician, in that ‘the doctor knows best’, and therefore such management decisions should be left in the experts’ hands. Patients with higher levels of education had significantly higher scores for ‘content’ (p=0.018) and ‘facilitation’ (p<0.001) on the MPP. Level of education was also statistically significant (p=0.036) for choice of role in the CPS, with those with less academic achievements preferring a passive role in decisions regarding treatment. Age, gender and medical variables had no statistically significant influence on response. Conclusions Maltese cancer patients want to be informed of their cancer diagnosis and clearly desire information about their condition, its treatment and its prognosis, with results similar to those from international studies, particularly British, American and Italian studies. However, a good proportion of Maltese patients (60%) seem to be inclined towards a more paternalistic approach towards their physician when it comes to decisions regarding their cancer treatment, when compared to results from international studies.