Bad news from the patient's perspective: an analysis of the written narratives of newly diagnosed cancer patients.

Papers in clinical journals dealing with how to tell cancer patients bad news rely mostly on the opinion of the physician. The purpose of the present study was to contribute with knowledge from the patient's perspective by analysing how patients with recently diagnosed cancer narrate the manner in which they received their diagnosis. A consecutive series of 187 patients who had received their cancer diagnosis 2-8 months prior to the outset of this study were asked to describe the manner in which they learned of their diagnosis in writing. A crucial finding from the submitted 138 written narratives was that the participants often described experiences from the first contact with hospital staff to the end of their treatment, rather than as a single instance of diagnosis communication. The relational meaning of these experiences was obvious. Information on treatment was of the utmost significance. No one required more prognostic information. From the perspective of the physicians, "bad news" focuses on how to provide information about diagnosis and prognosis in the course of a single diagnostic consultation. From the patient's perspective, "bad news" reflects the process of being diseased by cancer, and how medical services are available when one is in need of establishing a helpful relationship. In this relationship information about diagnosis and treatment is more a means than an end.