Communicating with patients with advanced cancer.

We conducted a prospective study of 130 unselected adults admitted to hospital with advanced malignancy. The study assessed how patients perceived information conveyed to them by physicians and the level of communication between patients and health care staff on questions relating to patients' understanding, pain control, and sense of well-being. Nearly 10% of patients were unaware of a diagnosis of cancer. Of those who knew their diagnosis, one quarter stated that the diagnosis was not disclosed in a clear or caring manner. One third of patients had an incomplete understanding of their prognosis, and patients generally overestimated their understanding when compared to hospital medical officers (HMOs) and nurses. The severity of pain was underestimated by the HMOs in 63% to 89% of patients. Thus HMOs require specific training in communication skills and the management of chronic cancer-related pain in patients with incurable cancer. Professional interpreters should be employed for all patients who are not fluent in English.