Supportive Care in Cancer

, Volume 15, Issue 7, pp 819–828 | Cite as

Reluctance to disclose difficult diagnoses: a narrative review comparing communication by psychiatrists and oncologists

  • Alex J. MitchellEmail author
Review Article



National guidance in most medical specialties supports the full and open disclosure of diagnoses to patients.


Surveys show that most patients want to know their diagnosis, whether it is medical or psychiatric, and a substantial proportion want to know detailed prognostic information. In the past, oncologists have been criticised for failing to reveal a diagnosis of cancer to patients in a sensitive and timely manner. Over the last 30 years, there is evidence that this practice has improved. Yet, clinicians still have difficulty when the diagnosis is not certain, when the prognosis is unfavourable, and when relatives request “not to tell.” All of these influences are present in mental health settings.


Psychiatrists and general practitioners may be equally reluctant to reveal difficult diagnoses and prognoses of conditions such as schizophrenia and dementia. The reluctance to reveal a difficult diagnosis may be a routine, but little acknowledged the aspect of medical care that should be incorporated into undergraduate and postgraduate education and openly discussed during peer group supervision.


Communication Diagnostic disclosure Stigma Trust Therapeutic alliance 



Thank you to the anonymous peer reviewers for their helpful comments during the preparation of this piece.


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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  1. 1.Department of Cancer Studies and Molecular MedicineLeicester Royal InfirmaryLeicesterUK

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