Breaking Bad News of a Cancer Diagnosis: A Mixed-Methods Study of Patients’ Perspectives

Wejdan M Al-Johani,1 Nouf A AlShamlan,1 Manar F AlGhamdi,2 Assim M AlAbdulkader,1 Waleed M Aljohani,3 Rehab F AlGhamdi,2 Munir Alrefae,4 Muna Alshehabi,5 Reem S AlOmar,1 Moataza M Abdel Wahab1 1Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, 34224, Saudi Arabia; 2College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 3Supply Chain Department, Security Forces Hospital, Dammam, Saudi Arabia; 4Department of Internal medicine, King Fahad Hospital of University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 5Palliative Medicine Department, King Fahad Specialist Hospital, Dammam, Saudi ArabiaCorrespondence: Wejdan M Al-Johani, Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam, 34224, Saudi Arabia, Tel +966599721175, Email wmaljohani@iau.edu.saPurpose: A cancer diagnosis is an overwhelming process for both patients and doctors. Many studies have addressed doctors’ opinions and knowledge regarding breaking bad news (BBN). However, scarce knowledge exists regarding patients’ perspectives for communicating bad news. Therefore, the current study aims to assess cancer patient preferences and satisfaction about BBN.Patients and Methods: This is a mixed methods study consisting of two phases; an in-depth interview and cross-sectional quantitative analysis. Thematic analysis was used for the qualitative data to explore patients’ satisfaction and preferences about BBN. For quantitative analyses, the overall satisfaction was calculated as satisfaction percent. Bivariate analyses were performed, and statistical significance was set as p < 0.05. Quality function deployment was used to effectively define patient requirements of highest priority.Results: Thematic analysis revealed two main themes. Theme 1; patients’ requirements for BBN and theme 2; patients’ reaction at the time of diagnosis with their categories. For the quantitative part, a total of 222 patients responded to the survey, females made up 70% of the sample. Satisfaction score percent ranged from 25.5 to 100%, with a mean of 82.7± 11.9%. The most preferred items were mainly concerned with the doctor being honest and encouraging, good listener and interacting giving simple smooth explanations without using medical terms, and empathetic (average score 4.8/5). Also, providing the diagnosis in a calm and private environment (4.7/5). Analysis also found that the requirements for improvement included providing a written summary after receiving the diagnosis and patient perception assessed by the doctor before telling the diagnosis.Conclusion: Communicating bad news effectively is crucial in the management of cancer patients. The process of BBN should be patient-centered, focusing on patients’ needs. Thus, the current study has demonstrated the patients’ preferences and the requirements, which should be incorporated into BBN protocols.Keywords: breaking bad news, cancer, patients’ preferences, patients’ satisfaction