• Asian Pacific Journal of Cancer Prevention
• /
• 제17권4호
• /
• pp.1779-1784
• /
• 2016

Background: Western physicians tend to favour complete disclosure of a cancer diagnosis to the patient, while non-Western physicians tend to limit disclosure and include families in the process; the latter approach is prevalent in clinical oncology practice in India. Few studies, however, have examined patient preferences with respect to disclosure or the role of family members in the process. Materials and Methods: Structured interviews were conducted with patients (N=127) in the medical oncology clinic of a tertiary referral hospital in Bangalore, India. Results: Patients ranged in age from 18-88 (M=52) and were mostly male (59%). Most patients (72%) wanted disclosure of the diagnosis cancer, a preference significantly associated with higher education and English proficiency. A majority wanted their families to be involved in the process. Patients who had wanted and not wanted disclosure differed with respect to their preferences regarding the particulars of disclosure (timing, approach, individuals involved, role of family members). Almost all patients wanted more information concerning their condition, about immediate medical issues such as treatments or side effects, rather than long-term or non-medical issues. Conclusions: While most cancer patients wanted disclosure of their disease, a smaller group wished that their cancer diagnosis had not been disclosed to them. Regardless of this difference in desire for disclosure, both groups sought similar specific information regarding their cancer and largely favoured involvement of close family in decision making. Additional studies evaluating the influence of factors such as disease stage or family relationships could help guide physicians when breaking bad news.

• Asian Pacific Journal of Cancer Prevention
• /
• 제15권6호
• /
• pp.2879-2882
• /
• 2014

Background: Breast cancer (BC) is the most common form of cancer in Iranian women, and it remains a major health problem. An increasing number of young women are being diagnosed with BC, and therefore, there is an increasing likelihood that more women will survive breast cancer for many years. Many opine that self-disclosure of BC diagnosis is important because talking about cancer helps people to make sense of their experiences; in fact, self-disclosure appears to play an important role in many health outcomes. However, this has not yet been studied in BC patients in Iran. Therefore, this study aimed to explore the status of self-disclosure of BC diagnosis by Iranian women to friends and colleagues. Materials and Methods: All BC records for 2001-2011 of employed women were studied at five hospitals in Mashhad. Data about the self-disclosure of BC diagnosis were gathered through telephone interviews, and the participants filled out a questionnaire about their status of self-disclosure of BC diagnosis to various groups of people. Results: The mean age of employed women at the time of diagnosis was $44.3{\pm}6.7$ years. Over 60% self-disclosed to work colleagues and over 90% to bosses/managers. Seventy per cent reported that they had support from their family and husband's family, while 95% reported that they had support from parents, siblings, children and friends. Conclusions: Most employed women self-disclosed freely to family, friends, colleagues and bosses/managers. Apparently, self-disclosure of breast cancer diagnosis may have negative effects at work. About half of patients reported that they had support from family, managers and colleagues; however, for nearly 28% of employed women, disclosure had less positive effects. In particular, it altered their perception of others, produced difficulties with work and family and diminished closeness with the people who were told. However, the stigma of BC is far less than it once was.

• Journal of Hospice and Palliative Care
• /
• 제7권2호
• /
• pp.169-178
• /
• 2004

목적: 환자, 가족, 의료진(의사, 간호사), 의과대학생, 간호대학생들의 시간의 흐름에 따른 병명통고에 대한 태도 변화를 알아보는 것이다. 방법: 2002년 10월부터 3 개월 간 가톨릭대학교 의과대학 부속 성모병원에서 전이성 암 환자, 조사대상 암 환자의 주 보호자, 암 환자의 간호 및 치료에 관련된 의료진(의사 및 간호사), 임상 실습 중인 의과 대학생, 간호대학생을 대상으로 각 군 50명씩 등록하여 암 환자의 병명통고에 관한 설문 조사를 실시하였다. 설문자료 평가 항목은 병명통고에 대한 찬성여부, 시기여부, 통고방법, 통고를 받기를 원하는 이유, 적합한 병명통고자가 누구인지였다. 환자 50명, 주 보호자 50명, 의료진 51명, 의과대학생 41명과 간호대학생 50명을 대상으로 하였다. 전이성 암환자 50명을 대상으로 하기로 하였으나, 전이성 암환자 34명만이 등록되었으며, 이외에 림프종 환자 16명을 포함하여 총 50명의 환자에게 설문조사를 진행하였다. 결과: 모든 설문 응답자들 가운데 89.3%가 병명통고에 찬성하였다(환자 98.0%, 주 보호자 88.0%, 의료진 90.2%, 의과대학생 73.2%, 간호대학생 94.0%). 림프종 환자를 제외한 진행성 암환자 34명을 대상으로 97.1%가 동의하였다. 병명통고 시기는 79.8%에서 진단 즉시 해주는 것을 선호하였다(환자 94.0%, 주 보호자 80.0%, 의료진 68.6%, 의과대학생 68.3%, 간호대학생 86.0%). 병명통고 방법은 64.4%에서 모든 내용을 한 번에 정확히 설명해주는 것을 선호하였다(환자 81.6%, 주 보호자 66.0%, 의료진 56%, 의과대학생 48.8%, 간호대학생 70.0%). 병명통고에 동의하는 이유에 대해서 모든 군에서 치료 참여가 가능한 것을 가장 큰 이유로 들었다. 병명통고를 누가하느냐는 문제에 대해서는 86.4%에서 의사가 병명통고를 하는 것이 적합하다고 응답하였다. 결론: 환자, 주 보호자, 의료진, 의과대학생 및 간호대학생의 병명통고에 대한 찬성률은 증가하였다. 병명통고 찬성 이유로 치료에 참여가 가능하다는 것을 가장 많이 선택하였다. 통고시기와 방법은 진단 즉시 모든 내용을 한 번에 정확히 알려주기를 원하였다.

• Asian Pacific Journal of Cancer Prevention
• /
• 제16권2호
• /
• pp.837-840
• /
• 2015

Background: The disclosure of a diagnosis of cancer is complex, particularly in older patients. The aim of this study was to investigate the association between age and not knowing the diagnosis, and its impact on mood. Materials and Methods: The study included 70 patients with various types of solid and hematologic cancer in early stages, which were followed up in an outpatient oncology/hematology clinic in Turkey between January, 2014 and June, 2014. Initially the caregivers of patients were asked whether the patients knew their diagnosis or not. A questionnaire for the Geriatric Depression Scale was then administered to the patients. Patient age, gender, marital status and education level were noted and analyzed with respect to knowing the diagnosis and depression. Results: Of the 70 patients, 40% of them were female. The mean age was $68.2{\pm}8.9$. The rate of the patients who does not know their diagnosis was 37.1% (n=26). The overall depression rate with GDS was found 37.1% (n=26) among the participants. There was no association with knowing the diagnosis (p=0.208) although the association between not knowing the diagnosis and age was significant (p=0.01). Conclusions: In this study we revealed no association between not knowing the diagnosis and depression in elderly patients. Contrary to what some has thought, the patient is not protected from psychological distress by not being informed about the diagnosis. We believe this study and similar ones will help to discuss and further explore patient autonomy, the principle of respect to self-determination and end of life issues in different cultures.

• Asian Pacific Journal of Cancer Prevention
• /
• 제14권2호
• /
• pp.1141-1145
• /
• 2013

Delay in seeking treatment for breast cancer is a barrier to the early diagnosis and management of the disease, resulting in a poorer prognosis. We here estimated the prevalence of delayed presentation for breast cancer and identified possible influential sociodemographic factors in a cross-sectional study of 250 patients diagnosed with primary breast cancer at the Radiotherapy and Oncology Clinic in Kuala Lumpur Hospital. Data were collected by face-to-face interview using a structured questionnaire and from medical records. We examined associations between delayed presentation (presenting to a physician more than 3 months after self-discovery of a symptom) and sociodemographic characteristics, practice of breast self examination (BSE), history of benign breast disease, family history of breast cancer and type of symptom, symptom disclosure and advice from others to seek treatment using multiple logistic regression. Time from self-discovery of symptom to presentation ranged from tghe same day to 5 years. Prevalence of delayed presentation was 33.1% (95%CI: 27.4, 39.3). A significantly higher proportion of delayers presented with late stages (stage III/IV) (58.3% vs. 26.9%, p<0.001). Divorced or widowed women (OR: 2.23, 95% CI: 1.11, 4.47) had a higher risk of delayed presentation than married women and women who never performed breast self examination were more likely to delay presentation compared to those who regularly performed BSE (OR: 2.74, 95% CI: 1.33, 5.64). Our findings indicate that delayed presentation for breast cancer symptoms among Malaysian women is high and that marital status and breast self examination play major roles in treatment-seeking for breast cancer symptoms.

• Asian Pacific Journal of Cancer Prevention
• /
• 제15권19호
• /
• pp.8135-8142
• /
• 2014

Background: Breast cancer is the most common cancer in Iranian women and usually features delayed presentation and late diagnosis. Interpretation of symptoms, as the most important step, has a significant impact on patient delay in seeking treatment. There is a dearth of studies on symptom appraisal and the process leading to seeking help in breast cancer patients. This study explored the perceptions and experiences of Iranian women with self-detected possible breast cancer symptoms. Materials and Methods: A qualitative method was conducted involving in-depth semi-structured interviews with 27 Iranian women with self-discovered breast cancer symptoms. Participants were purposefully selected from women who attended Cancer Institute of Tehran University of Medical Sciences during June 2012 to August 2013. The audiotaped interviews were transcribed and analyzed using conventional content analysis with MAXQDA soft ware version 10. The trustworthiness of the study was verified by prolonged engagement, member validation of codes, and thick description. Results: The main concepts emerging from data analysis were categorized in four categories: symptom recognition, labeling of symptoms, interactive understanding, and confronting the fear of cancer. Symptom recognition through breast self-examination, symptom monitoring and employing prior knowledge distinguished normal from abnormal symptoms and accompanied with perception of being at risk of breast cancer led to symptom labeling. Social interaction by selective disclosure and receiving reassurance from a consultant led to confirmation or redefinition of the situation. Perceived seriousness of the situation and social meanings of breast cancer as a stigmatized and incurable illness associated with loss of femininity were reasons for patient worries and fear. Conclusions: This study emphasized that entangled cognitive, emotional and socio-cultural responses affecting understanding of symptom seriousness require further investigation. It is suggested that programs aimed at shortening patient delay in breast cancer should be focused on improving women's knowledge and self-awareness of breast cancer, in addition to correcting their social beliefs.