Letting the cat out of the bag: shifting practices of cancer disclosure in Singapore

Tan SY, Narasimhalu K, Ong S
Correspondence: Dr Simon YK Ong, drmooyk@nccs.com.sg

ABSTRACT
Introduction Communication between patients and physicians is crucial in the disclosure of cancer diagnosis. Although westernisation of Asian societies has resulted in increased awareness of patient autonomy, the family continues to play an important influencing role in the disclosure process. Therefore, in this study, we aimed to characterise the experience of physicians with the disclosure of cancer diagnosis in a westernised Asian population.
Methods Oncologists at a tertiary hospital were approached to participate in this study. Information pertaining to the extent and approach to disclosure was collated. Logistic regression analysis was performed to characterise factors pertaining to the willingness of physicians to fully disclose a diagnosis of cancer.
Results In all, 25 oncologists (mean age 38 years; 72% men) responded to the survey. A majority of oncologists disclosed a cancer diagnosis directly to the patient over the first few visits. The main reason behind partial or nondisclosure was family objection. Ordinal logistic regression analysis showed that family resistance was the only significant predictor of reluctance to disclose a cancer diagnosis (p = 0.01).
Conclusion In this pilot study, contrary to previous reports, we found that oncologists were more likely to disclose a diagnosis of cancer to the patient first, that they do not accede fully to the family’s request for non-disclosure and that family resistance was the only significant predictor of reluctance to disclose a diagnosis of cancer.

Keywords: Asia, cancer, consent, disclosure, ethics
Singapore Med J 2012; 53(5): 344–348