Cancer diagnoses and the NHS App: should the ‘doctor in your pocket’ ever be the one to break bad news?

Earlier this week, the Health Service Journal (HSJ) published an interesting story (£) reporting that some patients are “discovering” their cancer diagnoses from test results or referrals uploaded to the NHS App before they have received the news from a healthcare professional. This is not completely surprising – the risk of this type of scenario arising has been widely discussed – but it highlights how technological advances and patient interests can collide. 

It would be easy to frame this as an example of the importance of human interactions and of the irreplaceable bedside manner of clinicians, but we should resist this interpretation, because it assumes an unrealistic uniformity amongst patients. Some people very much want bad news to be broken gently by a caring professional – but, as the article notes, some patients prefer receiving diagnostic results before appointments. For people who prefer it, receiving results in advance, in writing, can remove the stress and shock factor from the appointment and allow them to prepare questions about the things that matter to them. Not to mention that test results can be available days or weeks before an appointment – time that might otherwise be filled with anxiety and uncertainty. 

How we prefer to be treated and cared for is a very individual matter. Part of why interactions with health professionals are so important is that they are the space where our individual needs and preferences can and should be explored. We most often think about this in terms of treatment choice – surgery or physiotherapy; whether to undergo chemotherapy; etc – but it is as much about understanding individual preferences for communication and involvement. 

For me, the root problem in this story is a failure to understand and respond to people’s individual needs and preferences. This is expressed in two ways: 

• Choice: Some patients want their results as soon as possible – others want to wait for an expert to explain them. Neither is ‘wrong’: both are valid choices, and people waiting for a diagnosis are often going through one of the most stressful events of their life. Why can’t we ask them how they want to hear the results, and then act on their wishes? 

• Communication: Sensitive, clear communication of test results and diagnoses should be possible regardless of whether patients choose in-person or digital communication. It is unacceptable for a patient to receive incomprehensible test results and, as referenced in the article, need to call a charity helpline to find out that they indicate cancer – just as it is unacceptable for a doctor to break the news of a cancer diagnosis in a hurried, uncaring, and disinterested way. But an accessibly written letter, setting out test results and their implications in plain English and describing the next steps, can be every bit as acceptable as a kindly delivered face-to-face diagnosis, if this aligns with the patient’s preferences. 

We do not know how many people are receiving cancer diagnoses through the NHS App, but thanks to the National Cancer Patient Experience Survey (NCPES), coordinated by Picker for NHS England, we do know that only 75% of cancer patients were “definitely” told the diagnosis sensitively, and that only 77% had their diagnosis explained to them in a way that they could “completely” understand. These figures show that there is room for the NHS to improve the handling of cancer diagnoses, even before the planned and continued expansion of the NHS App as a communication tool, as outlined in the Ten Year Plan.   

To ensure high quality person centred care, providers and professionals should start by asking how each individual patient’s needs can be understood and met. Digital technologies, like the NHS App, will have a role to play in this, and they potentially offer important advantages around speed and responsiveness. But what this HSJ story demonstrates is the need for patients to have choice and control about their use, and for communications to be presented in a way that suits their individual needs. If these principles are overlooked, the irony is clear: healthcare may become more responsive and personalised yet feel less personal at the very moments that matter most.