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Impact of the disclosure of diagnosis on posttraumatic stress and growth and quality of life in Chinese patients with hepatocellular carcinoma

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Abstract

Purpose

To evaluate the impact of disclosure/nondisclosure of cancer diagnosis on patients’ posttraumatic stress symptoms (PTSS), posttraumatic growth (PTG), and quality of life (QOL).

Methods

Patients with primary hepatocellular carcinoma (HCC) who were admitted for potentially curative treatments in a teaching hospital were recruited. Patients were interviewed at admission regarding their QOL and their attitude towards disclosure of diagnosis. They were interviewed again for QOL, PTSS, and PTG at discharge and at 1 month after discharge.

Results

There were 300 patients recruited, 88.3% of whom preferred disclosure of cancer diagnosis. In fact, 162 patients (54.0%) received disclosure of their cancer diagnosis before discharge (disclosed group). However, for the 138 patients whose diagnoses were concealed by their families (uninformed group), 116 patients (84.1%) had learned of their diagnosis of HCC independently within 1 month after discharge. Comparing the scores at 1 month after discharge with scores at discharge showed that the PTSS score significantly declined for patients in the disclosed group and the PTG score significantly decreased for the uninformed patients at 1 month after discharge (p < 0.001 for both comparisons). Additionally, compared with the uninformed group, patients in the disclosed group had lower scores for PTSS (p < 0.001), higher scores for PTG (p < 0.001), better emotional functioning (p < 0.001), and better global QOL (p = 0.006) at 1 month after discharge.

Conclusions

Our findings indicate that concealing the diagnosis of cancer from patients is unlikely to succeed. Additionally, disclosure of diagnosis is beneficial for HCC patients in reducing PTSS and improving PTG and QOL.

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References

  1. Waly Raphael S, Yangde Z, Yuxiang C (2012) Hepatocellular carcinoma: focus on different aspects of management. ISRN Oncol 2012:421673

    PubMed  PubMed Central  Google Scholar 

  2. Wang DC, Guo CB, Peng X et al (2011) Is therapeutic non-disclosure still possible? A study on the awareness of cancer diagnosis in China. Support Care Cancer 19(8):1191–1195

    Article  PubMed  Google Scholar 

  3. Jie B, Qiu Y, Feng ZZ et al (2016) Impact of disclosure of diagnosis and patient autonomy on quality of life and illness perceptions in Chinese patients with liver cancer. Psycho-Oncology 25(8):927–932

    Article  PubMed  Google Scholar 

  4. Fan X, Huang H, Luo Q et al (2011) Quality of life in Chinese home-based advanced cancer patients: does awareness of cancer diagnosis matter? J Palliat Med 14(10):1104–1108

    Article  PubMed  Google Scholar 

  5. Liu Y, Yang J, Huo D et al (2018) Disclosure of cancer diagnosis in china: the incidence, patient’s situation, and different preferences between patients and their family members and related influence factors. Cancer Manag Res 10:2173–2181

    Article  PubMed  PubMed Central  Google Scholar 

  6. Li J, Yuan XL, Gao XH et al (2012) Whether, when, and who to disclose bad news to patients with cancer: a survey in 150 pairs of hospitalized patients with cancer and family members in China. Psycho-Oncology 21(7):778–784

    Article  CAS  PubMed  Google Scholar 

  7. Jiang Y, Liu C, Li JY et al (2007) Different attitudes of Chinese patients and their families toward truth telling of different stages of cancer. Psycho-oncology 16(10):928–936

    Article  PubMed  Google Scholar 

  8. Adellund HK, Jensen PT, Gilså HD (2016) Rehabilitation of women with gynecological cancer: the association between adult attachment, post-traumatic stress disorder and depression. Psycho-oncology 25(6):691–698

    Article  Google Scholar 

  9. Abbey G, Thompson SB, Hickish TA (2015) A meta-analysis of prevalence rates and moderating factors for cancer-related post-traumatic stress disorder. Psycho-oncology 24(4):371–381

    Article  PubMed  Google Scholar 

  10. Li YX, Zhang GQ (2013) The symptomatic characteristics of posttraumatic stress disorder of cancer patients and social psychology related factors. China J Health Psychol 21(4):515–517

    Google Scholar 

  11. Parikh D, De Ieso P, Garvey G et al (2015) Post-traumatic stress disorder and post-traumatic growth in breast cancer patients—a systematic review. Asian Pac J Cancer Prev 16(2):641–646

    Article  PubMed  Google Scholar 

  12. Su LP, Shi TY, Lu J et al (2014) Psychological experiences of post-traumatic growth in patients with primary liver cancer. Chin Nurs Res 28(10B):3632–3634

    Google Scholar 

  13. Montazeri A, Hole DJ, Milroy R et al (2004) Does knowledge of cancer diagnosis affect quality of life? A methodological challenge. BMC Cancer 19(4):21

    Article  Google Scholar 

  14. Bozcuk H, Erdogan V, Eken C et al (2002) Does awareness of diagnosis make any difference to quality of life? Determinants of emotional functioning in a group of cancer patients in Turkey. Support Care Cancer 10(1):51–57

    Article  CAS  PubMed  Google Scholar 

  15. Justo Roll I, Simms V, Harding R (2009) Multidimensional problems among advanced cancer patients in Cuba: awareness of diagnosis is associated with better patient status. J Pain Symptom Manag 37(3):325–330

    Article  Google Scholar 

  16. MontazeriA TA, Mohagheghi MA et al (2009) Disclosure of cancer diagnosis and quality of life in cancer patients: should it be the same everywhere? BMC Cancer 9:39. https://doi.org/10.1186/1471-2407-9-39

    Article  Google Scholar 

  17. Aggarwal AN, Singh N, Gupta D (2016) Does awareness of diagnosis influence health related quality of life in north Indian patients with lung cancer? Indian J Med Res 143(Supplement):S38–S44

    Article  PubMed  PubMed Central  Google Scholar 

  18. Weathers FW, Litz BT, Huska JA et al (1994) PCL-C for DSM-IV. National Center for PTSD—Behavioral Science Division, Boston

    Google Scholar 

  19. Wang XM, Liu J, Wang Q et al (2013) PTSD Checklist-civilian (PCL-C) Chinese reversion in cancer patients. Med Inf 26(3):62–63

    Google Scholar 

  20. Tedeschi RG, Calhoun LG (1996) The posttraumatic growth inventory: measuring the positive legacy of trauma. J Trauma Stress 9(3):455–471

    Article  CAS  PubMed  Google Scholar 

  21. Dong L, Hu Y, Xu G et al (2013) Reliability and validity of the Chinese version of post-traumatic growth inventory scale in breast cancer survivors. J Nurs Sci 28(22):21–23

    Google Scholar 

  22. Fan SY, Eiser C, Ho MC et al (2013) Health-related quality of life in patients with hepatocellular carcinoma: the mediation effects of illness perceptions and coping. Psycho-Oncology 22(6):1353–1360

    Article  PubMed  Google Scholar 

  23. Wan C, Meng Q, Yang Z et al (2008) Validation of the simplified Chinese version of EORTC QLQ-C30 from the measurement of five types of inpatients with cancer. Ann Oncol 19(12):2053–2060

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Bou Khalil R (2013) Attitudes, beliefs and perceptions regarding truth disclosure of cancer-related information in the Middle East: a review. Palliat Support Care 11(1):69–78

    Article  PubMed  Google Scholar 

  25. Zhang S, Yang Y, Yan D et al (2018) Internet videos and colorectal cancer in mainland China: a content analysis. BMC Med Inform Decis Mak 18(1):129. https://doi.org/10.1186/s12911-018-0711-x

    Article  PubMed  PubMed Central  Google Scholar 

  26. China Internet Network Information Center Basic Data (2017) https://cnnic.com.cn/IDR/ReportDownloads/201706/P020170608523740585924.pdf Accessed on 18 June 2017

  27. Richardson AE, Morton RP, Broadbent E (2016) Coping strategies predict post-traumatic stress in patients with head and neck cancer. Eur Arch Otorhinolaryngol 273:3385–3391

    Article  PubMed  Google Scholar 

  28. Mehnert A, Lehmann C, Graefen M et al (2010) Depression, anxiety, post-traumatic stress disorder and health-related quality of life and its association with social support in ambulatory prostate cancer patients. J Cancer Care (Engl) 19(6):736–745

    Article  CAS  Google Scholar 

  29. Koutrouli N, Anagnostopoulos F, Potamianos G (2012) Posttraumatic stress disorder and posttraumatic growth in breast cancer patients: a systematic review. Women Health 52:503–516

    Article  PubMed  Google Scholar 

  30. Danhauer SC, Case LD, Tedeschi R et al (2013) Predictors of posttraumatic growth in women with breast cancer. Psycho-Oncology 22:2676–2683

    Article  PubMed  Google Scholar 

  31. Shand LK, Cowlishaw S, Brooker JE et al (2015) Correlates of post-traumatic stress symptoms and growth in cancer patients: a systematic review and meta-analysis. Psycho-oncology 24(6):624–634

    Article  PubMed  Google Scholar 

  32. Figueiredo MI, Fries E, Ingram KM (2004) The role of disclosure patterns and unsupportive social interactions in the well-being of breast cancer patients. Psycho-oncology 13:96–105

    Article  PubMed  Google Scholar 

  33. Goldsmith DJ, Miller LE, Caughlin JP (2009) Openness and avoidance in couples communication about cancer. In: Beck CS (ed) Communication Year book, vol 31. New York, Routledge, pp 62–117

    Google Scholar 

  34. Zhou Q, Shen JC, Liu YZ et al (2014) Effects of doctor-patient communication on quality of life among breast cancer patients in southern China. Asian Pac J Cancer Prev 15(14):5639–5644

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors sincerely appreciate the patients for their participation and cooperation.

Funding

This study is supported by the grant from the National Social Science Fund of China (No. 16BSH096).

Author information

Authors and Affiliations

  1. Department of Military Developmental Psychology, School of Psychology, Third Military Medical University (Army Medical University), Chongqing, China

    Bin Jie & Guo-Yu Yang

  2. Department of Laboratory Medicine, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China

    You-Hong Zhou

  3. Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China

    Yan Qiu

  4. School of Psychology, Third Military Medical University (Army Medical University), Chongqing, China

    Zheng-Zhi Feng

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  1. Bin Jie
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  2. You-Hong Zhou
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  3. Yan Qiu
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  5. Zheng-Zhi Feng
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Corresponding author

Correspondence to Yan Qiu.

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This study was approved by the Ethics Committee of the Third Military Medical University (approval no. S-16096).

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The authors declare that they have no conflict of interest.

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Appendix 1 The routine procedure of disclosure of cancer diagnosis in Chinese hospitals and the procedure of consent in this study

Appendix 1 The routine procedure of disclosure of cancer diagnosis in Chinese hospitals and the procedure of consent in this study

In Chinese hospitals, the patient’s family members act as legitimate agents to receive information and make decisions for patients. In addition, according to the China’s Law on Medical Practitioners, medical professionals are obligated to try to avoid adverse effects on patients when informing them about the disease, and the Law allows physicians to circumvent direct patient disclosure by telling the truth to the patient’s family.

When it is related to disclosure/nondisclosure of cancer diagnosis, Chinese healthcare professionals and researchers have a consensus, which is, asking the patient’s family’s opinion first. In detail, when the physicians have made the definitive diagnosis of cancer, the patients would be informed of the cancer diagnosis if they state that they would like to know and their family members agree to tell the truth. However, if the patient’s family members insist on concealing the cancer diagnosis from the patient, he/she would be informed of the diagnosis of benign disease, such as hepatic hemangioma or benign liver tumor in this study, which is a lie about diagnosis.

Regarding the consent for study, we talked to patients’ family members about our research and made it clear that we would respect their family decisions and take no intervention on them or on the patients. With the verbal consent of the patient’s family, we then talked to the patient. Considering for patients whose families made the decision of nondisclosure, we could not tell them that we were doing a research on cancer patients who were informed/uninformed of their diagnosis. Therefore, we told all of the possible participants that we were studying the quality of life (QOL) and psychological rehabilitation of patients undergoing liver surgery (They were really going to have liver surgery). We also told them that we would interview them and assess their QOL and psychological status by questionnaires. Then the patient signed a written informed consent form if he/she agreed to participate in our study.

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Jie, B., Zhou, YH., Qiu, Y. et al. Impact of the disclosure of diagnosis on posttraumatic stress and growth and quality of life in Chinese patients with hepatocellular carcinoma. Support Care Cancer 28, 3371–3379 (2020). https://doi.org/10.1007/s00520-019-05141-0

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