Delivery of colorectal cancer diagnoses to colonoscopy patients by gastroenterologists

Background: Physician processes for delivering diagnostic news are poorly understood, despite the fact they have critical implications for patient follow-up and treatment. The current study assesses how gastroenterologists (GIs) deliver cancer diagnoses following colonoscopy and how patients perceive diagnosis reporting.

Methods: 30 GIs (mean age 45, 20% female) in university (hospital/clinic), VA, and suburban and rural settings participated in individual semi-structured interviews. GIs were asked to describe the content and setting of patient interactions following colonoscopy when cancer is suspected and/or confirmed and how they convey disease seriousness verbally and non-verbally. Interviews were transcribed and analysis followed an inductive process, allowing for identification of concepts and their interrelatedness. Colonoscopy patients at these clinics were recruited to participate in a colorectal cancer decision-making study. Patient data collection efforts, which include at-colonoscopy surveys and post-diagnosis interviews, are ongoing.

Results: Preliminary analysis suggests most GIs deliver a cancer diagnosis to patients in two steps: 1) disclosing suspected cancer in the recovery room post-colonoscopy and 2) confirming cancer following pathology. During step 1, most providers conveyed verbal seriousness of a suspected diagnosis by indicating they have “bad/unfortunate news,” using the word “cancer” or “malignancy”, describing the need for follow-up treatments/tests, and making referrals/appointments for surgery and/or oncology on the day of colonoscopy. 40% of GIs were unaware of their use of non-verbal cues to convey disease seriousness. Those who did described changing facial expression and voice tone. Other strategies included moving to a quiet environment, making sure a caregiver is present, sitting down, maintaining eye contact, talking with hands, pausing, and touch (e.g., hold hand). During step 2, providers report confirming the diagnosis by phone if cancer was initially suspected or by phone/in-person if not suspected. Providers indicated that telling patients they suspected cancer at colonoscopy was important preparation for the conversation confirming the diagnosis following pathology. These interactions were less difficult than conversations with patients with cancer not suspected at colonoscopy.

Conclusion: Communication of suspected cancer by GIs at colonoscopy plays an important role in preparing patients for a cancer diagnosis and most importantly, lays the foundation for future treatment decision making. These findings underscore the importance of interactions following a procedure complicated by sedation. These reports will be compared to patient reporting of their cancer diagnosis to assess discrepancies. Implications for research and practice are discussed.