Is cancer diagnosis via text message next? A new study finds women with breast cancer are increasingly likely to receive their diagnoses by phone rather than a face-to-face conversation with their doctor. Maybe this trend…
Is cancer diagnosis via text message next? A new study finds women with breast cancer are increasingly likely to receive their diagnoses by phone rather than a face-to-face conversation with their doctor.
Maybe this trend was inevitable, with the widespread use of smartphones and the ability to reach people right away. For many women with breast cancer, however, being available isn’t the same thing as being ready to learn devastating health news by phone.
Diagnosis While Driving
Becky Fields was behind the wheel when she got the news that changed her life. Three years ago, Fields was heading out from her work as vice president of a private bank in Tulsa, Oklahoma. “I live close to the office, so I drove home quickly as the nurse was explaining my diagnosis — while I was driving,” she says. “I pulled into my driveway and reached for a receipt on the back seat of my car.”
Lumpectomy, radiation, chemotherapy. With shaking hands, Fields jotted down these words on the receipt she still keeps. “The nurse had explained that I had an early stage of breast cancer, thankfully catching it early through my first mammogram,” she says. “I wrote the treatment plan they recommended.”
During the call, Fields also took down the name of the Susan G. Komen breast cancer organization, which the nurse recommended as a resource if she needed.
“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 mom. I had so many fears and questions, but those couldn’t be answered until I finally saw my doctor during our next visit.”
Ultimately, the treatment plan changed. It turned out Fields was not a candidate for a lumpectomy and she underwent a double mastectomy. Fortunately, because the cancer was caught early and didn’t spread to her lymph nodes, she was able to avoid radiation and chemotherapy.
For Fields, receiving the totally unexpected diagnosis over the phone was not OK. “The nurse who delivered my diagnosis was nice,” she says. “But if I could choose, I would certainly have preferred to have the doctor explain it with my family present, so I didn’t have to face that day alone.”
Fields is concerned that diagnosis via phone is becoming a common practice: It’s how she also recently learned she had melanoma.
Although Fields realizes that medical staff is extremely busy, she adds, “A diagnosis like this is so unsettling. It would greatly benefit the patient’s peace of mind to begin that process with a little hand-holding.”
Nearly 60 percent of women now learn of their breast cancer diagnoses by phone, compared to one-quarter of women in 2007, according to the study published online Aug. 17, 2018, in the journal Supportive Care in Cancer.
The results came from responses to an email survey of nearly 2,900 women diagnosed with breast cancer between 1967 and 2017. Over the last decade, the rate of women receiving their breast cancer diagnoses by phone rose significantly, according to the study led by Jane McElroy, an associate professor in family and community medicine at the University of Missouri School of Medicine.
Women who received the news over that phone 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 spreading cancer. A few women in the study had requested to receive a phone diagnosis.
An earlier study found a mismatch between women’s preferences and the reality of how they received their breast cancer diagnoses. Of about 785 breast cancer survivors, only 39 percent were given the diagnosis face-to-face, although half of participants would have chosen that method, according to findings in the October 2016 issue of the journal Annals of Surgical Oncology.
For many women in that study, avoiding suspense was important, with more than 80 percent preferring to receive their cancer biopsy results within two days. However, only 40 percent of participants found out their results that quickly.
In both studies, researchers pointed out that white women made up the vast majority of respondents, meaning results might not necessarily reflect the general population.
Cati Diamond Stone was in a restaurant having lunch with her husband when she took the call that told her she had breast cancer. Although she’s not a crier, Stone says, “It was certainly a cry-worthy call. But I was just stunned and went back to the table and tried to make some sense of it. I wasn’t able to finish my lunch, of course, and left pretty soon afterward.”
That was in April 2010. Stone, who is the executive director with Susan G. Komen Greater Atlanta, was an attorney at the time. The bad news wasn’t entirely without forewarning.
“My diagnosis happened very quickly,” Stone says. “The day before I had gone in for a mammogram. I was 35 years old, so they didn’t think there was anything to worry about.” However, she says, “When the radiologist assistant did the screening, she gasped. On the same day I went from a screening mammogram to a diagnostic mammogram to an ultrasound to three needle biopsies.”
Stone’s restaurant experience happened the next day, as she and her husband stopped to eat en route to the hospital for her scheduled MRI. “I thought it was an interesting way to deliver the news,” she says. “I did find it confusing that they didn’t tell me in person when I got to the hospital, as opposed to telling me on the phone an hour before.”
Learning the news that way only made it more difficult to handle. “It’s a terrifying phone call anyway,” Stone says. “But to have it in a place where you don’t have any privacy — how do you react when you’re in public and you get a diagnosis like that?”
Although Stone had “a zillion” questions, she was overwhelmed 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 I had some idea of what she was talking about, and I certainly did not.”
Had she instead learned of her diagnosis in person, Stone feels she would have been more empowered to seek answers. Now, through her work at Komen, she encounters many women with similar experiences.
“I have such trust and faith in these clinicians and their empathy for delivering a diagnosis like this,” Stone says. “But I would just say to make it as personal as possible, and to establish that connection with these women so they feel empowered to ask questions — and to not stop asking questions until they understand.”
It’s always troubling for doctors to give patients a diagnosis like breast cancer. “As surgeons, we’re frequently the ones giving patients the bad news,” says Dr. Emily Albright, a surgical oncology specialist with University of Missouri Health Care, and a co-author of the latest study. The finding that women are more likely to hear their diagnosis by phone wasn’t particularly surprising, she says.
“From a practical standpoint, many times it’s more convenient for patients to get the news over the phone; more to expedite their care,” Albright says. “The other issue that comes up is: Who gives the news? Especially our younger patients — they may not have a primary doctor that they have a relationship with.”
If patients are going to be diagnosed with a phone call, health care providers should do their best to prepare them. “Ask the person if it’s an appropriate time,” Albright advises.
A sudden stream of information is too much. “It’s helpful to allow for pauses in the conversation, to allow someone to digest what you have told them,” Albright says. “Sometimes, when you give the news over the phone, if you’re then able to have an in-person conversation shortly thereafter, it often gives the patient time to formulate questions or to maybe have a more productive discussion of the next steps.”
Being sensitive to the patient’s environment is also important, Albright notes: “Driving in the car is perhaps not the ideal moment for an over-the-phone conversation.” Regardless of whether it’s by phone or in person, she says, “As a physician, it’s never easy to give bad news. We want our patients to do well. And to give patients bad news hurts us, as well.”
For patients who know how they’d prefer to receive a diagnosis, “Please tell us,” Albright says. “But I also think it’s on us to ask if it’s OK to call you with results, or if you would like an appointment to discuss them.”