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Methods of communicating a primary diagnosis of breast cancer to patients

  • Review
  • Intervention

Authors

  • Karen Lockhart,

    Corresponding author
    1. Edinburgh Napier University, School of Nursing, Midwifery and Social Care, Faculty of Health, Life & Social Sciences, Edinburgh, Lothian, UK
    • Karen Lockhart, School of Nursing, Midwifery and Social Care, Faculty of Health, Life & Social Sciences, Edinburgh Napier University, Sighthill Campus, Sighthill Court, Edinburgh, Lothian, EH11 4BN, UK. k.lockhart@napier.ac.uk.

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  • Isabel Dosser,

    1. Edinburgh Napier University, School of Nursing, Midwifery and Social Care, Faculty of Health, Life & Social Sciences, Edinburgh, Lothian, UK
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  • Susanne Cruickshank,

    1. Edinburgh Napier University, School of Nursing, Midwifery and Social Care, Faculty of Health, Life & Social Sciences, Edinburgh, Lothian, UK
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  • Catriona Kennedy

    1. University of Limerick, Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Limerick, Ireland
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Abstract

Background

The method of delivering a diagnosis of breast cancer to women has the potential to impact on their level of interpretation, patient recall and satisfaction.

Objectives

To assess the effectiveness of different methods when used to communicate a primary diagnosis of breast cancer to women.

Search methods

We searched the Cochrane Breast Cancer Group Specialised Register on 7th September 2006, Cochrane Consumers and Communication Group on 27th October 2006, MEDLINE (1966 to present), CINAHL (1982 to present), EMBASE OVID (1980 to present), British Nursing Index (Jan 1984 to present), PsycInfo (1967 to present), Dissertation Abstracts International (2004 to 2006), Library and Info Science Abstracts (LISA) (1969 to present), ISI Web of Knowledge (conference abstracts) and reference lists of articles.

Selection criteria

Randomised controlled trials of women with a histologically confirmed diagnosis of breast cancer receiving a diagnosis of primary breast cancer. Trials should have used one or more of the following methods; face-to-face consultations, written information, telephone consultation, audio or video tapes of consultation.

Data collection and analysis

Two review authors independently assessed trials for inclusion in the review. Studies were to have been assessed using standardised data extraction and quality assessment forms.

Main results

The search strategies identified 2847 citations overall. A total of 30 citations appeared relevant however there were three duplicates which left 27 articles for further review. Articles reporting the same primary data accounted for 6 of the publications Brown 1997; Brown 1998; Brown 1999; Brown 2000; Hack 2000; Hack 2003 which left 23 original papers to be reviewed for inclusion. Of these, none met the inclusion criteria. Data extraction and assessment of methodological quality was therefore not possible.

Authors' conclusions

The review question remains unanswered as there were no randomised trials of methods of communicating a diagnosis of breast cancer to women. The authors have considered the possible reasons for the lack of research studies in this area and have considered that it is perhaps unethical to randomise women at such a vulnerable time such as waiting for a diagnosis. The design of ethically sensitive research to examine this topic needs to be explored to inform future practice. As some papers reviewed by the authors related to the first consultation visit, where treatment options are discussed, perhaps a review which focused on the methods of communication at the first consultation visit would provide more reliable evidence for the effectiveness of methods of communication and overcome the ethical dilemmas previously mentioned.

アブストラクト

乳癌の一次診断を患者に伝える方法

背景

女性に乳癌の診断を伝える方法は、解釈の程度、患者の想起および満足感に影響を及ぼすようである。

目的

乳癌の一次診断を女性に伝えるために用いた場合の様々な伝達方法の有効性を評価する。

検索戦略

2006年9月7日にCochrane Breast Cancer Group Specialised Register、2006年10月27日にCochrane Consumers and Communication Group、MEDLINE(1966年~現時点)、CINAHL(1982年~現時点)、EMBASE OVID(1980年~現時点)、British Nursing Index(1984年1月~現時点)、PsycInfo(1967年~現時点)、Dissertation Abstracts International(2004年~2006年)、Library and Info Science Abstracts(LISA)(1969年~現時点)、ISI Web of Knowledge(学会大会の抄録)および論文の参照文献リストを検索した。

選択基準

組織学的に乳癌と確定診断され、原発性乳癌と診断された女性に関するランダム化比較試験を検索した。また、試験では以下の方法のうちひとつ以上が使用されていることとした。対面診察、書面による情報伝達、電話相談、相談に関するオーディオテープまたはビデオテープ。

データ収集と分析

2名のレビューアが独自に試験を本レビューに含めるかどうかを評価した。標準化されたデータ抽出および質の評価書式を用いて研究を評価した。

主な結果

検索戦略により、全部で2847件の引用が同定された。計30件の引用が関連すると思われたが、内3件は重複していたため、残りの27件の論文をさらにレビューした。同一の一次データに基づいて報告された論文が6件(Brown 1997年、Brown 1998年、Brown 1999年、Brown 2000年、Hack 2000年、Hack 2003年の発表)あったため、残りの23件の原著をレビューに含めた。この内、選択基準を満たすものはなかった。従って、データの抽出および方法論の評価はできなかった。

著者の結論

乳癌の診断を女性に伝える方法に関するランダム化試験はなかったことから、レビューの疑問の回答は得られないままである。レビューアは本領域における調査研究がないことについて予測される理由を検討した。診断を待っているような精神的に不安定な時期にある女性をランダム化することはおそらく非倫理的であると考える。この問題を調べるための倫理的にデリケートな研究のデザインは、その後の診療についての情報を伝えるために模索する必要がある。レビューした幾つかの論文は、治療の選択肢について議論する場である、最初の相談のための受診に関連したものであったことから、おそらく最初の相談のための受診時における伝達方法に焦点を当てたレビューを行えば、伝達方法の有効性についてより信頼性の高いエビデンスが提供され、先に述べた倫理上のジレンマが克服されるであろう。

訳注

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Translation supported by:

Plain language summary

Ways of communicating to a woman that she has breast cancer

For women to wait for and receive a first diagnosis of breast cancer (primary diagnosis) is an extremely stressful experience. Studies conducted to date suggest that what a woman is told at this time has the potential to influence her sense of well being, the way she copes with the news, how much she remembers of what was discussed (her recall) and her overall level of satisfaction with the encounter.
The diagnosis of confirmed breast cancer can be delivered in a variety of ways, including face-to-face consultation, telephone consultation, written or audiovisual materials. This information can be given by a range of health professionals, such as general practitioners or specialists.

The present systematic review set out to assess the effectiveness of various methods of communicating a first diagnosis of confirmed breast cancer. The review was particularly interested in how this would impact on what the patient remembered, the satisfaction with the information received, the coping strategies used as a result of the information given and the impact of receiving the information on the patient's quality of life. The review authors made a thorough search of the medical literature looking for controlled trials in which women receiving a first diagnosis of breast cancer were randomised to the intervention group. They retrieved 23 original reports of trials for further review but ultimately no trial could be included. A number of the trials focused on communication at the first treatment consultation rather than the method of delivering the diagnosis. In an area that is ethically sensitive, the authors suggest that a review which focuses on the various methods of communication at the first consultation visit may provide useful information as to which methods are more effective and beneficial for this patient group.