Sir,

Hospital-based clinicians may face special difficulties when disclosing a diagnosis of malignancy, lacking pre-existing longitudinal relationships with patients.1 Ophthalmologists in a Canadian survey perceived a need for training in breaking bad news pertaining to ocular malignancies.2

We conducted a prospective service evaluation to determine what diagnostic information is provided by referring clinicians to patients referred to the Liverpool Ocular Oncology Centre (LOOC) with suspected ocular malignancy. We further investigated patients’ perspectives on information disclosure. Questionnaires were provided to patients who were diagnosed with choroidal/ciliary body melanoma at LOOC over a 5-month period. A total of 50 of 61 patients (82%) (24 male, 26 female; mean age 61 years) completed questionnaires.

Uveal melanoma was the suspected diagnosis in 80% of referral letters. In all, 64% of the patients stated that they had been informed by their referring clinician that they may have a malignancy, 30% stated they had not been told, and 6% were unsure. In all, 52% said they had been given a diagnosis.

In all, 64% of the patients felt that the referrer should be the person to inform a patient about possible malignancy, whereas 34% felt that this should be disclosed by LOOC, unless the patient specifically asks (2% abstained).

Of patients who had been informed about possible malignancy by their referrers, 58% (n=18) felt that this had not caused them additional anxiety before their LOOC appointment. Overall, 81% (n=25) felt that this had allowed them to be better prepared for the appointment.

The context for disclosing a diagnosis of malignancy should be determined by patient preferences, which vary.1 Ophthalmologists should take note that most patients in our survey felt that this responsibility lay with the referrer. Despite the fact that uveal melanoma was suspected in most referral letters, a substantial proportion of patients stated that they were not informed about possible malignancy. Clinicians can be reassured that most patients feel that disclosure of this information by the referrer does not unnecessarily increase their anxiety. This is supported by comments from cancer patients in another study who report, not uncommonly, that ‘receiving bad news is not as difficult as anticipating it’.3