Share this Article
Kao YH, Goh CR
Correspondence: Dr Yung Hsiang Kao, email@example.com
Introduction The traditional family-centred approach to cancer management in Singapore often leads to nondisclosure of diagnosis to patients with advanced cancer. This study aimed to determine the rate of nondisclosure to such patients in Singapore, and compare it against the rate of nondisclosure to patients’ families and that of a study conducted in 1992.
Methods Consecutive patients (n = 100) with advanced cancer who were referred to a palliative home care service in 2004 were studied retrospectively. Comparison between the 1992 and present study groups was performed using chi-square and Fisher’s exact tests. Multivariate logistic regression was applied to patient age, Eastern Cooperative Oncology Group (ECOG) performance status, gender and ethnicity to identify factors associated with nondisclosure.
Results The overall nondisclosure rate among patients with advanced cancer was 23% (23/100), compared to only 2% (2/99) among their families (p < 0.001). The nondisclosure rates among ECOG 0–2 and ECOG 3–4 patients were 11% (7/62) and 42% (16/38), respectively (p < 0.001). There was no significant improvement in the nondisclosure rate among ECOG 3–4 patients when compared to the 1992 study (p = 0.94). It was more likely for nondisclosure to occur among patients aged ≥ 70 years (p < 0.001; odds ratio [OR] 14.77, 95% confidence interval [CI] 3.68–59.26) and those with poor ECOG performance status (p = 0.019; OR 4.0, 95% CI 1.26–12.73). There was no significant association between nondisclosure and gender or ethnicity (p > 0.05).
Conclusion Disclosure of diagnosis to patients with advanced cancer remains a challenge in Singapore. The relationship between nondisclosure and advanced age, as well as nondisclosure and poor ECOG performance status, needs to be clarified with further studies.
Keywords: cancer, diagnosis disclosure, family-centred, palliative, Singapore
Singapore Med J 2013; 54(5): 255-258; http://dx.doi.org/10.11622/smedj.2013103
|1. Lee A, Wu HY. Diagnosis disclosure in cancer patients—when the family says "no!". Singapore Med J 2002; 43:533-8.|
| 2. Back MF, Huak CY. Family centred decision making and non-disclosure of diagnosis in a South East Asian oncology practice. Psychooncology 2005; 14:1052-9. |
| 3. Tay WK, Shaw RJ, Goh CR. A survey of symptoms in hospice patients in Singapore. Ann Acad Med Singapore 1994; 23:191-6. |
| 4. Yun YH, Kwon YC, Lee MK, et al. Experiences and attitudes of patients with terminal cancer and their family caregivers toward the disclosure of terminal illness. J Clin Oncol 2010; 28:1950-7. |
| 5. Jiang Y, Liu C, Li JY, et al. Different attitudes of Chinese patients and their families toward truth telling of different stages of cancer. Psychooncology 2007; 16:928-36. |
| 6. Yun YH, Lee CG, Kim SY, et al. The attitudes of cancer patients and their families toward the disclosure of terminal illness. J Clin Oncol 2004; 22:307-14. |
| 7. Wang SY, Chen CH, Chen YS, Huang HL. The attitude toward truth telling of cancer in Taiwan. J Psychosom Res 2004; 57:53-8. |
| 8. Miyata H, Takahashi M, Saito T, et al. Disclosure preferences regarding cancer diagnosis and prognosis: to tell or not to tell? J Med Ethics 2005; 31:447-51. |
| 9. Chiu LQ, Lee WS, Gao F, et al. Cancer patients' preferences for communication of unfavourable news: an Asian perspective. Support Care Cancer 2006; 14:818-24. |
|10. Seow A, Koh WP, Chia KS, et al. Trends in cancer incidence in Singapore 1968-2002. Singapore Cancer Registry Report No. 6. Singapore: National Registry of Diseases Office, 2004.|
| 11. Chan D, Goh LG. The doctor-patient relationship: a survey of attitudes and practices of doctors in Singapore. Bioethics 2000; 14:58-76. |
| 12. Lin CC, Tsay HF. Relationships among perceived diagnostic disclosure, health locus of control, and levels of hope in Taiwanese cancer patients. Psychooncology 2005; 14:376-85. |
| 13. Phungrassami T, Sriplung H, Roka A, et al. Disclosure of a cancer diagnosis in Thai patients treated with radiotherapy. Soc Sci Med 2003; 57:1675-82. |
| 14. Horikawa N, Yamazaki T, Sagawa M, Nagata T. Changes in disclosure of information to cancer patients in a general hospital in Japan. Gen Hosp Psychiatry 2000; 22:37-42. |
| 15. Miyata H, Tachimori H, Takahashi M, Saito T, Kai I. Disclosure of cancer diagnosis and prognosis: a survey of the general public's attitudes toward doctors and family holding discretionary powers. BMC Med Ethics 2004; 5:E7. |
| 16. Fujimori M, Uchitomi Y. Preferences of cancer patients regarding communication of bad news: a systematic literature review. Jpn J Clin Oncol 2009; 39:201-16. |
| 17. Tan TK, Teo FC, Wong K, Lim HL. Cancer: to tell or not to tell? Singapore Med J 1993; 34:202-3. |
| 18. Lin CC. Disclosure of the cancer diagnosis as it relates to the quality of pain management among patients with cancer pain in Taiwan. J Pain Symptom Manage 1999; 18:331-7. |
| 19. Horikawa N, Yamazaki T, Sagawa M, Nagata T. The disclosure of information to cancer patients and its relationship to their mental state in a consultation-liaison psychiatry setting in Japan. Gen Hosp Psychiatry 1999; 21:368-73. |
| 20. Buckman R. Talking to patients about cancer. BMJ 1996; 313:699-700. |
|21. Girgis A, Sanson-Fisher RW. Breaking bad news: consensus guidelines for medical practitioners. J Clin Oncol 1995; 13:2449-56.|
|22. Ngo-Metzger Q, August KJ, Srinivasan M, Liao S, Meyskens FL Jr. End-of-Life care: guidelines for patient-centered communication. Am Fam Physician 2008; 77:167-74.|
|23. Clayton JM, Hancock KM, Butow PN, et al. Clinical practice guidelines for communicating prognosis and end-of-life issues with adults in the advanced stages of a life-limiting illness, and their caregivers. Med J Aust 2007; 186(12 Suppl):S77, S79, S83-108.|
|24. Economist Intelligence Unit. The quality of death. Ranking end-of-life care across the world. London: Economist Intelligence Unit, 2010.|