Telling "everything" but Not "too Much": the Surgeon's Dilemma in Consultations About Breast Cancer

Background: Although clinicians are often criticized for giving inadequate information to patients with cancer, current recommendations to "provide full information" or "all the information patients want" are impractical. We therefore examined how surgeons manage information-giving to patients with breast cancer in practice, and how their approach compared with what patients wanted.

Study Design: We interviewed 20 patients consulting after surgery in a specialist breast unit, and the eight surgeons whom they consulted. Qualitative analysis examined surgeon and patient perspectives on the purposes of information.

Results: Surgeons and patients both stated the importance of "honesty" and "telling everything" but surgeons did not want to tell everything they could and patients did not want to hear it. Patients wanted information mainly to maintain hope, demonstrate the surgeon's expertise, and sustain a personal clinical relationship. Surgeons shaped their information-giving for the same reasons while providing necessary information about histology and treatment.

Conclusions: Surgeons and patients agreed strikingly about the purposes of information and indicated that giving information is a more complex task than current recommendations imply. We suggest that expert recommendations should catch up with practice rather than the reverse. That is, if recommendations are to reflect patients' real rather than assumed needs, and be realistic about how surgeons can meet these needs, the recommendations should be informed by knowledge of how patients and surgeons already reconcile these needs in clinical practice.