From the Guidelines
A junior doctor should consult with a senior doctor or specialist before informing a 75-year-old patient about an adenocarcinoma diagnosis following a colonoscopy. This approach ensures the patient receives accurate, comprehensive information about their condition, prognosis, and treatment options. According to the SIOG expert recommendations 1, elderly patients with colorectal cancer are often undertreated due to concerns about postoperative morbidity and mortality, and they are less likely to receive adjuvant chemotherapy and/or radiotherapy.
When discussing the diagnosis with the patient, it is essential to consider the patient's age, comorbidities, and physical and mental frailty, as these factors can impact their tolerance of surgery and/or chemotherapy 1. The conversation should ideally include discussion of the specific type of adenocarcinoma, its location, staging information if available, and next steps for treatment planning. Senior clinicians can better address complex questions about survival rates, treatment side effects, and quality of life considerations, as they have more experience in managing similar cases.
Some key points to consider when discussing the diagnosis with the patient include:
- The importance of curative resection in improving overall survival, particularly in elderly patients 1
- The potential benefits and risks of adjuvant chemotherapy and/or radiotherapy in elderly patients with colorectal cancer 1
- The need for a multidisciplinary approach to manage the patient's care, including involvement of specialists such as surgeons, oncologists, and geriatricians 1
- The importance of addressing the patient's emotional and psychological needs, as well as their physical needs, during the diagnosis and treatment process.
By consulting with a senior doctor or specialist, junior doctors can ensure that patients receive high-quality, patient-centered care that takes into account their individual needs and circumstances. This collaborative approach also provides emotional support for the junior doctor in delivering difficult news and ensures the patient receives consistent information from the healthcare team.
From the Research
Diagnosis and Communication of Adenocarcinoma
- The diagnosis of adenocarcinoma in a 75-year-old patient after a colonoscopy is a significant finding that requires careful consideration and communication 2, 3.
- While the provided studies primarily focus on gastric adenocarcinoma, the principles of diagnosis, treatment, and patient communication can be applied to other types of adenocarcinoma.
Role of the Junior Doctor in Communicating Diagnosis
- As a junior doctor, it is essential to consider the patient's emotional and psychological well-being when communicating the diagnosis 4, 5.
- However, there is no direct evidence in the provided studies to suggest that a junior doctor should inform the patient of the adenocarcinoma diagnosis alone.
Involvement of a Senior Doctor or Specialist
- It is recommended to consult a senior doctor or specialist to deliver the news, as they can provide more comprehensive information about the diagnosis, treatment options, and prognosis 6.
- A multidisciplinary approach to patient care, involving senior doctors, specialists, and other healthcare professionals, can ensure that the patient receives the best possible care and support.
Key Considerations
- When communicating the diagnosis to the patient, it is crucial to consider their individual needs, preferences, and values 3, 5.
- The patient should be provided with clear and accurate information about their diagnosis, treatment options, and prognosis, and should be involved in the decision-making process whenever possible.