What is the best way to inform a patient that their computed tomography (CT) scan suggests a diagnosis of cancer?

How to Inform a Patient of a Suspected Cancer Diagnosis on CT Imaging

Deliver the news in person during a private, uninterrupted meeting where you sit down at the patient's level, first assess what they already understand and want to know, then provide the information clearly in simple language while responding empathically to their emotions. 1

Prepare the Setting and Approach

• Schedule an in-person meeting rather than delivering this news by phone or email, ensuring you have adequate uninterrupted time in a quiet, private location 1
• Sit down at the patient's level to convey you are not rushed and have time for them 2
• Invite a support person if the patient wishes, as companions often ask more questions (62% of questions in oncology consultations) and help with information processing 1
• Ensure privacy with an unobstructed exit path and maintain appropriate personal space (two arms' length) 2

Assess the Patient's Understanding First

Before delivering the news, orient yourself to where the patient is starting from:

• Ask what they already know: "Please tell me what you understand about why we did the CT scan" 1
• Ask what they want to know: "What are the things you want to make sure we discuss today?" 1, 2
• Provide a warning shot: "I have the results of your CT scan and I need to discuss some concerning findings with you. Is now a good time?" 1

This approach prevents information overload and tailors your discussion to their readiness and preferences. 1

Deliver the Information Clearly

• Use simple, direct language without medical jargon: Say "the scan shows what appears to be cancer" rather than "there's a suspicious lesion with malignant characteristics" 1
• Provide information in small chunks, stopping frequently to check comprehension 1
• Be honest but leave room for hope by explaining next steps: "This appears to be cancer, but we need a biopsy to confirm it, and then we can discuss treatment options" 1, 3
• Avoid information overload: Focus on 2-3 key pieces of information initially (the finding, need for confirmation, immediate next steps) rather than overwhelming them with staging, prognosis, and treatment details 1

Respond to Emotions Empathically

Pause and respond to emotions before continuing with more information, as patients in highly emotional states cannot process information effectively. 1, 4

• Acknowledge and name the emotion: "I can see this news is very upsetting" or "This is clearly shocking to hear" 1
• Use partnership statements: "I want to make sure we do everything we can to get you the best outcome" or "We will work through this together" 1
• Allow silence and give the patient time to react before proceeding 2
• Explore their concerns: "What are you most worried about right now?" or "What has been going through your mind?" 1

Check Understanding and Plan Next Steps

• Use teach-back method: "In your own words, what does this mean to you?" or "What will you tell your family about what we discussed?" 1, 2
• Provide clear next steps: Explain specifically what diagnostic procedures are needed (biopsy type, timing, who will perform it) 1
• Assure availability: "I'm available to answer questions as they come up" and schedule a follow-up discussion 1
• Document the discussion in the medical record 1

Common Pitfalls to Avoid

• Don't provide excessive detail about staging, prognosis, or treatment options during the initial disclosure when emotions are high—save this for subsequent visits when the patient can better process information 1, 4
• Don't use euphemisms like "growth" or "mass" when you suspect cancer—be direct but compassionate 1, 3
• Don't assume the patient wants minimal information or doesn't want to participate—ask directly what they want to know 2
• Don't rush through the conversation—the mean length of bad news discussions in oncology is 37 minutes, with 63% spent on diagnosis and treatment discussion 1

Special Considerations

If this represents a misdiagnosis correction (previous imaging was read as benign), recognize that these patients require special attention to rebuild trust, as they often report subsequent mistrust of physician information. 5 Be particularly transparent about what changed and why.

Recognize that multiple pieces of concerning information may need to be discussed (not just the cancer finding, but also staging implications, need for invasive procedures, treatment complexity), so plan for this to be the first of several conversations rather than a single disclosure. 1