BMJ  2004;328:E307 (12 June), doi:10.1136/bmj.328.7453.E307

BMJ USA: Letter

RAPID RESPONSES FROM BMJ.COM

Communication: information and choice are vital

While we acknowledge the importance of qualitative research, we have some concerns about the Wright study.

The stated objective of the study was to determine how a small group of patients with breast cancer wanted their doctors to communicate with them. When this aim was addressed through a structured questionnaire, its findings "concurred with the current emphasis on information, choice and emotional discussion." This should come as no surprise as this is the result of solid and substantial research showing how highly these three factors are valued by patients.

The aim of the study seems to have then shifted from an examination of communication, of which the imparting of information is an integral part, to an analysis of doctors' characteristics and behavior, and how doctors communicate trust, care, and respect.

No one could be surprised by the finding that technical expertise, the ability to form individual relationships, and respect for the patient were highly valued. To conclude from this, however, that the provision of information and choice were therefore not valued seems odd, especially when many of the comments made under these three broad headings focus on how well the doctor communicated accurate information (ie, "She answers questions with no hesitation"; "He lied, or fibbed, or spared your feelings"). Patients clearly linked trust to feeling they had been "given the facts."

The comments patients made about choice are already widely understood and acknowledged. What patients generally regard as choice is clear information, communicated in a sensitive, respectful manner, about the various merits of different treatments, and why their doctor is recommending one over another.

To conclude that the study shows that patients "are not well served by some forms of communication that are currently thought important, including information, choice, and emotional discussion," and to suggest that "patients do not generally seek information to be better informed but to maintain hope and trust" is plain wrong.

This study makes some interesting points about a patient's natural desire for attachment, trust, and respect in their relationship with their doctor. It is one thing, however, to focus on how these attributes contribute to good communication but quite another to use these findings to denigrate the provision of information, choice, and emotional discussion. To draw such conclusions from this study is misguided.

Information and choice are an intrinsic part of building attachment, trust, and respect, and they are highly valued in themselves. Extensive research and the experiences of the thousands of people who use our services clearly demonstrate this. Information and choice are what people say they want.

CancerBACUP London, UK

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