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Is SMS cancer diagnosis the next step? Women with breast cancer are increasingly likely to receive their diagnosis over the phone rather than through a face-to-face conversation with their doctor, a new study finds.
This trend was perhaps inevitable, with the widespread use of smartphones and the ability to reach people right away. For many women with breast cancerhowever, being available is not the same as being ready to hear devastating health news over the phone.
Becky Fields was driving when she heard the life-changing news. Three years ago, Fields quit her job as vice president of a private bank in Tulsa, Oklahoma. “I live close to the office, so I got home quickly while the nurse explained my diagnosis – while I was driving,” she says. “I parked in my driveway and took a receipt from the back seat of my car.”
Lumpectomy, radiotherapy, chemotherapy. With shaking hands, Fields jotted down those words on the receipt she still keeps. “The nurse explained to me that I had early stage breast cancer, luckily she caught it early on my first mammogram,” she says. “I wrote down the treatment plan they recommended.”
During the call, Fields also wrote down the name of the Susan G. Komen breast cancer organization, which the nurse recommended as a resource if she needed it.
“I didn’t know what I needed at the time,” Fields says. “I was in shock. I hung up the phone and called my boyfriend and my mum. I had so many fears and questions but couldn’t answer them until I finally saw my doctor on our next visit.”
Eventually, the treatment plan changed. It turned out that Fields was not a candidate for a lumpectomy and she had a double mastectomy. Luckily, since the cancer was caught early and didn’t spread to her lymph nodes, she was able to avoid the radiation and chemotherapy.
For Fields, receiving the completely unexpected diagnosis over the phone was not acceptable. “The nurse who delivered my diagnosis was nice,” she says. “But if I could choose, I would certainly have preferred the doctor to explain to me in the presence of my family, so that I would not have to face this day alone.”
Fields worries that diagnosis by phone will become common practice: that’s how she also recently learned that she had melanoma.
Although Fields realizes that the medical staff are extremely busy, she adds, “A diagnosis like this is so disturbing. It would greatly benefit the patient’s peace of mind to begin this process with a bit of a grip.
Less face-to-face diagnosis
Nearly 60 percent of women are now learning their breast cancer diagnoses by telephone, compared to a quarter of women in 2007, according to the study published online August 17, 2018 in the journal Supportive Care in Cancer.
The findings come from responses to an email survey of nearly 2,900 women diagnosed with breast cancer between 1967 and 2017. Over the past decade, the rate of women receiving their breast cancer diagnosis over the phone increased significantly, according to the study led by Jane McElroy, associate professor of family and community medicine at the University of Missouri School of Medicine.
Women who received the news by telephone were more likely to have family and friends identified as support members, and were somewhat more likely to have localized breast cancer, rather than invasive or enduring cancer. spread. A few women in the study had asked to receive a diagnosis over the phone.
One earlier study found a disconnect between women’s preferences and the reality of how they received their breast cancer diagnosis. Of about 785 breast cancer survivors, only 39% received the diagnosis face-to-face, although half of participants chose this method, according to findings from the October 2016 issue of the journal Annals of Surgical Oncology.
For many women in this study, avoiding the suspense was important, with more than 80% preferring to receive their cancer biopsy results within two days. However, only 40% of participants discovered their results that quickly.
In both studies, the researchers pointed out that white women made up the vast majority of respondents, meaning the results don’t necessarily reflect the general population.
Cati Diamond Stone was at a restaurant having lunch with her husband when she took the call who told her she had breast cancer. Although she’s not a screamer, Stone says, “It was definitely a cry-worthy call. But I was just stunned and went back to the table and tried to make sense of it. I don’t couldn’t finish my lunch, of course, and left soon after.”
It was April 2010. Stone, who is the executive director of Susan G. Komen Greater Atlanta, was an attorney at the time. The bad news was not entirely without warning.
“My diagnosis came very quickly,” Stone says. “The day before, I had gone for a mammogram. I was 35, so they didn’t think there was anything to worry about.” However, she says, “When the radiologist assistant did the screening, she gasped. That same day, I went from a screening mammogram to a diagnostic mammogram, ultrasound and three biopsies at the needle.”
Stone’s restaurant experience happened the next day, when she and her husband stopped to eat en route to the hospital for his scheduled MRI. “I thought it was an interesting way to convey the news,” she says. “I found it confusing that they didn’t tell me in person when I got to the hospital, instead telling me on the phone an hour before.”
Hearing the news this way only made it harder to handle. “It’s a terrifying phone call anyway,” Stone says. “But to have it in a place where you have no privacy – how do you react when you’re out in public and you get a diagnosis like that?”
Although Stone had “a million” questions, she was inundated with technical information, none of which she understood at the time. “There was compassion in the voice of the nurse who called, of course,” she says. “But she took it for granted that I had some idea of what she was talking about, and that was definitely not the case.”
Had she learned of her diagnosis in person instead, Stone believes she would have been better able to look for answers. Now, through her work at Komen, she meets many women with similar experiences.
“I have such confidence and faith in these clinicians and their empathy to deliver a diagnosis like this,” Stone says. “But I would just say make it as personal as possible and make that connection with these women so they feel empowered to ask questions – and don’t stop asking questions until they understand. .”
It is always troubling for doctors to give patients a diagnosis such as breast cancer. “As surgeons, we’re often the ones breaking bad news to patients,” says Dr. Emily Albright, surgical oncology specialist with the University of Missouri Health Care and co-author of the latest study. The finding that women are more likely to hear their diagnosis over the phone wasn’t particularly surprising, she says.
“From a practical perspective, it’s often more convenient for patients to get the news over the phone; more to expedite their care,” Albright says. “The other question that arises is, who is giving the news? Especially our young patients – they may not have a primary care physician that they have a relationship with.”
If patients are to be diagnosed by phone call, health care providers should do their best to prepare them. “Ask the person if this is an appropriate time,” advises Albright.
A sudden flow of information is too much. “It’s helpful to allow pauses in the conversation, to allow someone to digest what you’ve said to them,” says Albright. “Sometimes when you break the news over the phone, if you’re able to have a conversation in person soon after, that often gives the patient time to formulate questions or maybe have a more productive discussion. on next steps.”
Being sensitive to the patient’s surroundings is also important, Albright notes: “Driving in a car may not be the ideal time for a phone conversation.” Whether on the phone or in person, she says, “As a doctor, it’s never easy to break bad news. We want our patients to be well. And breaking bad news to patients hurts us. too.”
For patients who know how they would prefer receive a diagnosis, “Please tell us,” said Albright. “But I also think it’s up to us to ask if it’s OK to call you with the results, or if you want an appointment to discuss it.”
