Annals of Oncology 8: 857-863, 1997.

1997 Kluwer Academic Publishers. Printed in the Netherlands.

Original article
The dynamics of change: Cancer patients' preferences for information,
involvement and support
P. N. Butow,1 M. Maclean,1 S. M. Dunn,1 M. H. N. Tattersall2 & M. J. Boyer3
^Medical Psychology Unit, Department of Medicine, 2Department ofCancer Medicine, University of Sydney, Sydney, * Department of Medical
Oncology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia

the consultation. Demographic and disease data were recorded for each patient.
Results: General preferences for information and involveBackground: While the importance of providing individualised
communication to cancer patients is now well recognised, little ment were relatively stable, at least in the short term; however
is known about the stability and validity of patients' expressed there was considerable variability in preferences for specific
preferences for information and involvement in decision-mak- topics of information. Patients whose condition had recently
ing. This study explored the stability and possible predictors of worsened were more likely to want progressively less involvement in decision-making. Gender, the doctor seen and religion
such preferences over time.
Patients and methods: Cancer patients seeing two Medical were also predictive of patient preferences.
Conclusions: Situational factors, such as change in disease
Oncologists in an out-patient clinic at an Australian teaching
hospital completed a questionnaire battery before and directly status, may alter a patient's preferences for information and
after one consultation, and before their next consultation. involvement. If we wish to match the provision of information
Eighty consecutive patients with heterogeneous cancers par- and support to the expressed needs of patients, we must ask
ticipated in the study. Preferences for general and specific patients at each consultation what those needs are.
information, involvement and support were elicited at each
assessment. Locus of control and patient familiarity with the
clinic were measured before the first consultation. Patient Key words: information, involvement, preferences, stability,
satisfaction with the consultation was assessed directly after support
Summary

Contemporary medical ethics emphasise the right of the

cancer patient to be fully informed of his or her medical
condition and to participate in decisions about treatment [1, 2]. Community attitudes have also shifted
towards greater patient information and participation
in medical matters [3, 4]. While the legal rationale for
this approach is to safeguard the autonomy and integrity
of the individual, psychological explanations have emphasised the critical processes of adjustment to lifethreatening illness. One author has, for example, proposed that positive adjustment involves the extraction of
personal meaning from the situation and the maintenance of a sense of mastery or control and positive
self esteem [5]. Seeking information and being involved
in decision-making are thought to contribute to these
coping processes.
Some doctors have suggested that in the attempt to
fulfil perceived moral and/or legal obligations, the individual patient's true wishes and best interests may be
overlooked or poorly served [6, 7]. Evidence regarding a
majority preference for involvement in decision-making
is conflicting [8-11], but in all reported studies there is a

significant proportion of patients who prefer minimal

information and/or a passive role. One explanation for
this diversity in preferences is that patients cope with
life threatening illnesses in different ways. 'Monitors'
actively seek information while 'blunters' avoid or distract themselves from the information [12]. In one study,
patients who reported the highest amount of satisfaction
with the information they had received, tended to be
more avoidant in their coping style (i.e., blunters) [13].
Monitors had the least satisfaction, but in contrast
actually possessed greater factual knowledge. Thus
'forcing' information on a blunter may be as injurious
as withholding it from a monitor.
Others have suggested that information and involvement preferences may change when a person becomes
ill. Degner [10], for example, found that while the
majority of well people preferred an active role in decision-making, most sick people preferred the doctor to
make decisions. Degner argued that the sick person is
not simply a well person with a disease, but rather is
qualitatively different, not only physically but socially,
emotionally, and even cognitively [14]. At a time when
they may feel physically unwell and overwhelmed with
anxiety, many patients appear to sanction a degree of

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Introduction

858
Patients and methods
Subjects were consecutive cancer patients attending out-patient consultations with either of two participating medical oncologists at a
university teaching hospital. Exclusion criteria were age less than 16,
non-English speaking or advanced incapacity (unable to complete the
questionnaire because of physical or mental disability). Eighty-nine
patients were invited to participate in the study and nine declined;
three felt too unwell, four felt they had already contributed enough to
departmental research and two believed this study was only appropriate for patients with terminal cancer. Demographic and disease characteristics of the 80 recruited patients are shown in Table 1.
Prior to the consultation, subjects completed a battery of questionnaires measuring information and involvement preferences, locus of
control and familiarity with the clinic setting. Immediately after the
consultation their information and involvement preferences were reassessed and they completed a satisfaction questionnaire. Prior to their
next appointment (usually three to six months later) patients again
completed the information and involvement preferences questionnaire.

Measures
Information and involvement preferences were assessed, encompassing:
i. General information preferences, measured by two items from
the Cassileth Information Styles Questionnaire (3), measuring
Table 1. Demographic and disease characteristics of the patients
(n = 80).
Characteristic
Age (years)
Mean
Range
Time between consultations 1 and 2 (months)
Mean
Range
Gender
Male
Female
Marital status
Single
Married
Divorced /separated
Widowed
Attendance
Accompanied
Alone
Type of cancer
Breast
Genitourinary
Colon
Lung
Other
Prognosis*
Weeks or months
Years
Normal life expectancy
Clinical condition*
Improving
Deteriorating
About the same
Purpose of consultation*
New patient consultation
Routine follow-up
Follow up with significant change found
* As nominated by the oncologist.

Value

15
18-87
3
1-8
25%
75%
14%
71%
9%
6%
64%
36%
43%
31%
6%
6%
13%
33
55
12
11
26
63
10
66
24

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paternalism in decision-making, by opting to exercise

their 'autonomous choice of dependency' [15, 16].
Achieving the elusive balance between under-informing and over-loading the patient is important, because
patient dissatisfaction with communication has been
linked to non-compliance with medical advice [17],
'doctor shopping' - comparing and going between doctors [18], poorer coping [19] and general dissatisfaction
[20]. Available data suggest that doctors are not very
good at estimating the amount and type of information
patients want nor how effective they have been in imparting information [8, 21, 22]. One study [23] found
that doctors underestimated hypertensive patients' desire for information while overestimating their desire for
participation in decision-making. Because of these difficulties, it has been suggested that doctors should measure patients' information and involvement preferences
more objectively. A variety of questionnaires have been
developed for this purpose [3, 24]. However, little is
known about the reliability and validity of such measures, or whether information preferences remain stable
over time and circumstance. Is an information preference a fixed personality characteristic or behavioural
strategy? Should such preferences be established once,
or throughout the course of managing a disease?
Several studies have identified stable predictors of
information and involvement preferences, such as age,
gender and education [3, 24]. Situational factors - the
purpose and type (i.e., new patient versus follow-up) of
the consultation, the presence or absence of a companion - have not only been shown to influence doctorpatient communication [25, 26], but it is argued that
they may be associated with changes in patients' preferences for information and involvement.
The type of information presented in a consultation
may be a factor in destabilising preferences; for example, if a patient is told of a major change in prognosis,
previously stable information patterns may alter to
assimilate this new threat. It is also suggested that
patients' preferences vary depending on the length of
their relationship with their doctor, and their degree of
comfort and trust in the clinical setting. Patients may
want information so that they can understand the logic
of their doctors' recommendations and develop a sense
of trust in him/her, not so they can synthesise and use
the information themselves [27]. It seems that once
patients feel confident that the doctor will make the
right decision, there is no longer any need to absorb or
retain the facts.
In this study we examined the stability of cancer
patients' information, involvement and support preferences over time and explored possible predictors of
these preferences. We hypothesised that general preferences would be relatively stable, while preferences within specific content areas would be influenced by medical
intervention (attending a consultation), the passage of
time and changes in the patient's condition.

859
the amount of detail required (on a five-point Liken scale) and
the type of information ('only sufficient to care for myself, 'only
good news' or 'all news'),
ii) Involvement preferences, using the Sutherland, LlewellynThomas, Lockwood et al. [28] scale which measures the preferred
level of involvement in decision-making (five categories ranging
from 'patient only' to 'doctor only" making decisions), and
iii) Specific information and support preferences, using 12 items
adapted from the Cassileth Information Styles Questionnaire
[3]. The items address the desire for information about such
aspects as diagnosis, prognosis and treatment options and
desire for support in the form of reassurance, a chance to talk
about worries and fears, and assurance of being looked after
well. Items from the Cassileth questionnaire were presented to a
panel of patients and health professionals working in cancer
care, who were asked to verify the items and suggest additional
items. The scale has good internal reliability, with a Cronbach's
alpha level of 0.89 and item-total correlations ranging from 0.47
to 0.71.

Statistical analysis
Differences in general information and involvement preferences before
and after consultation 1, as well as before consultation 2, were tested
using the Wilcoxon matched pairs signed-ranks test. An average rank
order for specific information and support was calculated at each time
point.
As the information and involvement preference scores (derived
from 5 point Likert scales) were ordinal, change scores for pre and
post consultation 1 and for pre-consultation 2 were calculated by
subtraction. Negative scores were categorised as representing a desire

Results
Sample
All 80 patients completed the questionnaires before and
immediately after their first assessed consultation. Forty
of these patients completed the pre-consultation questionnaire at their next visit. Of those who were lost to
follow-up, 12 had died, four did not return to the clinic,
two refused, 10 did not return to the clinic within the
study period and 12 were lost due to administrative
difficulties. Patients who completed the pre-consultation
questionnaire at their next visit and those lost to followup were similar on all variables measured except gender:
65% of males vs. 38% of females did not complete the
pre-consultation 2 questionnaire.
Information and involvement preferences
Pre-consultation 1
Twelve subjects (15%) wanted minimal detail about their
illness, while 68 (85%) wanted a large amount of detail.
While 29 subjects (36.3%) favoured an equal and collaborative role in decision-making, only 18 (22.6%)
sought an active role. A sizeable minority (33, or 41.3%)
preferred to take a more passive role by leaving decisionmaking in the hands of the doctor.
From the 12 specific information and support topics
listed, patients expressed the greatest need for information. Of the three highest ranking topics, 97% of patients
wanted more feedback on what is happening to the
cancer; 88% expressed a desire for increased information on the likely future of their illness, and 91% wished
for more information about their illness.
Post-consultation I
Patient needs immediately after the first consultation
shifted to an emphasis on support. Of the three highest
ranking topics, 63% of patients wanted more assurance
that they would be looked after; 59% wished for greater
reassurance and hope, and 59% expressed an increased
need to talk about their worries and fears.
Pre-consultation 2
Patients indicated a desire for both information and
support prior to their next visit. Ninety-two percent of
patients sought more information on the likely future of
their cancer, 80% wanted more feedback about what is
happening to the cancer, and 72% indicated a need for
reassurance and hope.

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Patient satisfaction with the consultation was assessed during the

follow-up phase using a 25 item Likert scale adapted from Roter [29]
and Korsch et al. [30]. A total score for satisfaction was calculated. The
internal reliability of the scale in this sample was high (Cronbach's
Alpha = 0.92). The scale has been used in several previous studies [31,
32] to assess satisfaction with:
i) the amount of information presented, for example, 'the doctor
gave me the right amount of information about my illness and
treatment';
ii) the communication skills demonstrated by the doctor, for
example,
a) 'the doctor used medical terms without explaining their
meaning',
b) 'the doctor listened to what I said';
iii) the level of patient participation in the consultation, for example,
a) 'I participated in the consultation as much as I wanted to',
b) 'I was able to talk in the consultation as much as I wanted
to'.
The scale has differentiated levels of satisfaction between patients
receiving and not receiving an audiotape of their consultation [31].
Locus of control was measured using the Cancer Locus of Control
scale (Watson et al. [33]). Locus of control is defined as the attribution
of specific events to either personal (internal control) or situational
(external control) elements. The Cancer Locus of Control scale is a 17
item multi-choice scale with three subscales: internal control over the
(i) cause and (ii) course of the illness, and (iii) religious control over the
cause and course of the illness.
Familiarity and comfort with the out-patient clinic were measured by
four questions each scored on a five-point Likert scale, covering
aspects such as knowing what to expect when attending the clinic,
understanding the way the clinic works, feeling comfortable in the
clinic and knowing the doctor.
At the end of each consultation, the medical oncologist completed
questions about the patient's current clinical condition ('improving',
'about the same' or 'deteriorating'), probable prognosis (days, weeks,
months, years or normal life expectancy) and the purpose of the
consultation ('new patient consultation', 'routine follow-up' or 'followup with significant change').

for more information or involvement, scores of zero as a desire for

equivalent information and involvement and positive scores as a desire
for less information and involvement after consultation 1 or before
consultation 2. Predictors of change were explored using the MannWhitney U - Wilcoxon Rank Sum W test for dichotomous variables
and the Kruskal-Wallis one-way Anova for variables with 3 or more
categories. Predictors of satisfaction with the consultation were explored with multiple linear regression.

860
Change in information and involvement preferences

Specific measures
The hypothesis that specific information needs would be
less stable over time was supported by the data. The
percentage of patients indicating the same preference
for information before and after consultation 1 ranged
between 24% (for feedback about what is happening to
the cancer) to 46% (for information about risks to the
family). However, preferences were more stable across
consultations, with 38% to 53% of patients indicating
the same scores. The percentages of individual patients
Table 2. Percent of patients expressing the same versus different
general information and involvement preferences, compared to preconsultation scores.
Preference

% of patients
Pre consult
1 vs. post
consult 1

Amount of detail: few to many

Same detail
71"
Less detail
26
More detail
3
Extent of information: all, only good, minima]
Same information
76"
Less information
19
More information
5
Involvement in decisions: doctor only,
patient only, doctor and patient
74C
Same involvement
24
Less involvement
More involvement
2
'P < 0.001.
b
P < 0.05.
c
P < 0.01.

Pre consult
1 vs. pre
consult 2
53 b
35
12
83
10
7

31"
23
46

Predictors ofgeneral information and involvement

preferences
We examined the relationships between information and
involvement preferences prior to consultation 1, and
Table 3. Percent of patients expressing the same versus different
specific information preferences, compared to pre-consultation scores.
Preference for amount
(Likert scale, 15)

% of patients
Pre consult
1 vs. post
consult 1

Information about diagnosis

28*
Same information
66
Less information
6
More information
Feedback about what is happening to the cancer
24*
Same feedback
71
Less feedback
More feedback
5
Information about prognosis
Same information
32*
Less information
62
More information
6
Information about treatment options anc1
side effects
Same information
35'
Less information
61
More information
4
Treatment recommendation
Same recommendation
34'
Less recommendation
57
More recommendation
9
Information about goals of treatment
38*
Same information
Less information
54
More information
8
Information about risks to family
46*
Same information
47
Less information
7
More information
*P< 0.001.
b
P < 0.01.
c
P < 0.05.

Pre consult
1 vs. pre
consult 2
53"
40
7
45C
45
10
50
25
25

38
33
29
48
28
24
38C
40
22
40
35
25

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General measures
As expected, general measures were relatively stable in
the short term, with 71%-76% of patients recording the
same preferences before and after consultation 1. The
remainder showed a clear shift towards a desire for less
information and involvement directly after seeing their
doctor (z = -3.6, P < 0.001 for amount of details and
z = -2.21, P < 0.05; for type of information and
z = -3.02, P < 0.01 for involvement). The percentages
of individual patients expressing same and different
preferences between time periods are shown in Table 2.
By the time of the second consultation, i.e., after the
three to six month period between consultations, the
type of information desired (i.e., good or bad news)
remained stable (86% of patients recording the same
preference). However, approximately two thirds of patients changed their preferences for amount of detail and
involvement with the majority wanting less detailed
information and more involvement in decision-making
by the time of their second visit (z = -1.9, P < 0.05 for
amount of details; z = -0.5, P = 0.6 for type of information and z = -2.2, P < 0.05 for involvement).

expressing same and different preferences between time

points are shown in Tables 3 and 4.
The Wilcoxon matched-pairs signed-ranks test confirmed that the differences in preference before and after
the first consultation were highly significant (P < 0.001
on most items), with most patients indicating a reduced
need for information and support. However as many or
more patients indicated an increased need for a chance
to talk about worries or fears and emotional support.
Differences between preferences prior to the first and
second consultations were insignificant, except on three
items: information about illness (z = -2.4, P < 0.01),
feedback on what is happening to the cancer (z = -2.0,
P < 0.05) and information about goals of medical care
(z = -2.0, P < 0.05). Patients wanted less information in
all three content areas at their second visit.

861
Table 4. Percent of patients expressing the same versus different
support preferences, compared to pre-consultation scores.
Preference for amount
(Lilcert scale, 1-5)

Pre consult
1 vs. post
consult 1

Pre consult
1 vs. pre
consult 2

18
39
43

50
25
25

41"
38
21

38
28
34

41 b
43
16

52
24
24

48 b
41
11

48
25
27

47
29
24

30
22
48

* P < 0.05.
b
P < 0.001.

age, gender, presence of family or friend at the consultation, purpose of the consultation, doctor seen, cancer
site, prognosis, clinical condition and locus of control.
Significant relationships were found only for gender,
purpose of consultation and one subscale of the locus of
control scale, locus of religious control. The Wilcoxon
rank sum test indicated that females wanted significantly more detailed information than males (z = -2.2,
P < 0.05). Patients attending for the first time were
significantly more likely to seek greater involvement in
decision-making, while those whose follow-up visit encompassed a significant change to their condition were
more likely to prefer the doctor to make decisions (chisquare = 7.9, P < 0.05). Unfortunately, the response
options did not clarify whether the significant change
was negative or positive, although the vast majority of
changes identified at follow-up would have been negative (a recurrence, or new symptoms). Finally, patients
who believed that God influenced the development or
course of their illness were more likely to prefer fewer
details (F = 10.5, P < 0.0001) and minimal information
(F = 4.8, P < 0.01) prior to their first consultation.
Predictors of changed information and involvement
preferences
We explored predictors of change in the preference for
either less or more information and involvement both

Discussion
The study demonstrated that general information and
involvement preferences were relatively stable in the
short term despite medical intervention, with 71%76%
of patients maintaining their preferences before and
directly after a consultation with a medical oncologist.
However, by the time of their next consultation (usually
between three to six months), patients' preferences had
shifted considerably, with only 31% of patients recording the same preference for involvement in decision
making and 53% desiring the same amount of detail.
These results suggest that using a single assessment of
information and involvement may be unreliable, given
that situational factors influence patient's needs for
information and involvement over time. In this par-

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Chance to talk about worries and fears

Same chance
Less chance
More chance
Assurance I will be looked after well
Same assurance
Less assurance
More assurance
Reassurance and hope
Same reassurance
Less reassurance
More reassurance
Chance to talk about how cancer has
affected life
Same chance
Less chance
More chance
Emotion support
Same support
Less support
More support

% of patients

before versus after consultation 1, and before consultation 1 versus before consultation 2. Change scores were
calculated by subtracting scores from pre-consultation
1. Negative scores were categorised as representing a
desire for more information or involvement, scores of
zero as a desire for equivalent information and involvement and positive scores as a desire for less information
and involvement after consultation 1 or before consultation 2.'
Age, gender, marital status, type of cancer, prognosis
or clinical condition were not related to change in
information nor involvement preferences. However, patients who saw one of the study doctors were significantly more likely to shift their preference towards less
information (only good news, or minimum need for selfcare) following consultation 1 than patients who saw the
other study doctor (chi-square = 5.0, P < 0.01).
The purpose of the consultation was related to
change in involvement preferences both after consultation 1, and before consultation 2. Both new patients and
those having a routine follow-up were more likely to
change towards desiring greater involvement, while
those having a follow-up visit at which significant
change to their condition was discussed were more likely
to remain stable in their involvement preference (before
and after consultation 1, chi-square = 7.2, P < 0.01;
between consultations 1 and 2, chi-square = 7.9, P <
0.01). These data suggest that both new patients and
those having routine follow-ups, who expressed a greater desire for involvement at consultation 1, strengthened
that desire over time.
Satisfaction with the consultation was significantly
related to stability in the preferred amount of details
(F = 4.2, P < 0.05). Post-hoc comparisons with the
Bonferroni correction revealed that patients who remained stable were more satisfied (mean satisfaction
score = 69%) than those who wanted more details
immediately after their first consultation (mean satisfaction = 60%) (P < 0.05). Satisfaction with the consultation was not related to stability in involvement preferences.

862
culture of individualism, consumerism and positive
thinking which generates quite different approaches to
discussing illness.
In this study, patients who wanted more details upon
leaving the consultation tended to be less satisfied with
the consultation than those whose preferences remained
the same. Perhaps the information needs of these patients were not met by the consultation, thus generating
a heightened need for detail. Or perhaps new issues were
introduced in the consultation which raised new questions in the patient's mind. Alternatively, these patients
may be 'monitors', whose need to attend to threatening
information is ongoing, and who therefore find it difficult to gain satisfaction from a medical encounter. In
any case, it appears that patients view information
delivery as an important function of the consultation
which, if not fulfilled, leads to significant dissatisfaction.
On the whole however, information needs appeared
to be met for the majority of patients. The percentage of
patients wanting more specific information and support
directly after the consultation was significantly fewer
than before it. In 71% of cases, patients preference for
feedback was reduced after the initial consultation.
Prior to the first consultation, the largest proportion
of patients expressed mostly informational needs: feedback about the cancer and information about prognosis,
their illness and treatment options. Interestingly, the
focus shifted to support after the first visit, with the
largest proportion of patients seeking assurance that
they would be looked after well, reassurance and hope
and a chance to talk about their worries and fears.
For example, 43% of patients felt an increased need to
talk about their fears and worries directly after the
consultation, and 24% felt they needed more emotional
support.
This study did not gather detailed information about
the content of the consultations, and so we are unable to
determine why such emotional needs may have arisen.
Whatever the cause, if patients left the consultation feeling that these needs were unmet, either they did not seek
support from the Oncologist, or their attempts to seek
support were not adequately addressed. These data suggest that the recent emphasis on doctor-patient communication has had positive effects in terms of information
delivery; however, the supportive aspects of communication may not yet meet patient needs. Acknowledging
that system constraints may make it difficult and indeed
inappropriate for doctors to address such needs in an
outpatient setting, it is suggested that other services
should be considered in order to adequately provide for
this aspect of patient care.
There were several methodological deficiences in
the present study which could be addressed in future
research. Educational status was not measured, which
could be a significant predictor of both initial and later
information and involvement preferences. The time between consultations varied between patients, and this
may have had an impact on the results. Also a more
detailed assessment of changes in clinical status between

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ticular sample, patients whose status had worsened before the first consultation maintained a preference for
the doctor to make treatment decisions, whilst those
who were attending for routine follow up were more
likely to move towards preferring more information and
involvement.
These results support Williamson's [15] view that
seriously ill people may prefer a degree of paternalism
in their care. An active role in decision-making may take
more physical and mental energy than such patients can
afford. Or perhaps there is a limit to the amount of
negative and pessimistic information people can absorb
before their capacity for coping is seriously compromised. On the other hand, patients whose initial shock
and fear has dissipated and who are faced with a prognosis better than their worst fears, may wish to hear
progressively more information because it is reassuring
and reinforces a sense of control. The wish to provide
socially desirable responses may also reassert itself in
patients whose condition is improving. As we did not
measure this variable, we could not control for it in the
analysis.
The fact that patients of one doctor (male) wanted
less information after the consultation than patients of
the other doctor (also male) suggests that doctor behaviour may also influence patients' expressed preferences.
Perhaps patients respond to doctors subtle, non-verbal
expression of preferences for providing information and
involving patients in decision making. Social scientists
have for many years characterised the doctor-patient
relationship as involving standardised behavioural expectations, generally of doctor activity and patient passivity. Pendleton [34], for example, emphasised that both
parties have role expectations, and that these are influenced by institutional and social frameworks. Patients
may enter a consultation viewing passivity as 'acceptable
and appropriate' patient behaviour, perhaps due to past
experiences whereby doctors have operated within a
paternalistic or authoritarian framework, but emerge
with a different view as a result of their current doctor's
behaviour. Thus it is part of the doctors responsibility to
be aware of the messages he or she may be giving out.
Apart from gender and the purpose of the consultation, the only predictor of pre-consultation preferences
was locus of religious control. This rinding reflects the
significant influence that religion and culture can have
in determining attitudes towards information and the
role of the physician, the patient-physician interaction
and the role of the family when a member is ill [35]. In a
cross-cultural study, for example, Ali et al. [36] noted
that in Egypt the "patient must be dependent and nurtured, and is not to be involved in decision-making... It
is the family that makes decisions in Egypt because
dignity, identity and security are bounded by belonging
to the family." Therefore "disclosure of the exact serious
diagnosis to a patient by the physician is a socially
unacceptable behaviour and an untactful act. However
the family is informed of the diagnosis and the plan of
care." This approach is in contrast to the American

863
consultations may have allowed a better understanding
of the factors influencing change of preferences.
In conclusion, information and involvement preferences do not appear to be fixed personality characteristics, but rather are highly responsive to a number of
factors, such as changing disease status and the behaviour of the doctor in the consultation. While the categorisation of patients into 'monitors' and 'blunters' appears
to offer some useful predictive power, it is clear that
these issues are more complex. If we wish to match the
provision of information and support to the expressed
needs of patients, we must ask patients at each consultation what their needs are.

16.
17.
18.

19.

20.

21.
22.

Acknowledgements
23.
24.

25.

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Received 2 May 1997; accepted 13 August 1997.

Correspondence to:
Dr. Phyllis Butow, PhD
Medical Psychology Unit
Department of Medicine
University of Sydney
Sydney, NSW 2006 Australia

Downloaded from http://annonc.oxfordjournals.org/ by guest on November 9, 2016

The authors wish to gratefully acknowledge the contribution of Ms. Sharon Dowsett in the final preparation
of this manuscript.

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