'Yours is potentially serious but most of these are cured': optimistic communication in UK outpatient oncology consultations

Objective: To describe how experienced doctors discuss radiotherapy and chemotherapy with cancer patients about to undergo such treatment. Methods: Qualitative analysis of 27 consultations between consultant oncologists and patients with breast, head, and neck cancer or gastrointestinal cancer. Set in outpatient oncology clinics: one in the South West, one in the Midlands, and a large London teaching hospital. Participants included three experienced consultant oncologists and 27 patients diagnosed with cancer attending outpatient oncology consultations to discuss radiotherapy or chemotherapy. Results: Doctors repeatedly invoked optimism when discussing bad and uncertain information about radiotherapy and chemotherapy. This was achieved by following relatively bad or uncertain information with some good information. Patients tended to collaborate in the construction of optimism. Conclusions: Doctors talked optimistically while sharing information about chemotherapy and radiotherapy with patients about to undergo such treatment. Research indicates that patients want their doctors to openly share bad and uncertain information, but to do so sensitively. Following uncertain or bad tidings with relatively better news was one way in which doctors delivered information honestly without diminishing opportunities for hope in the consultation room or optimism about the future. Findings from qualitative empirical studies, such as that described, provide a valuable educational adjunct to the role play and simulated patient interactions, often used in conventional communication skills training and research. Copyright (C) 2008 John Wiley & Sons, Ltd.