Rethinking Disclosure In Advanced Cancer: Cultural Variations In Patient Communication Preferences

Background and Purpose: Delivering quality care for advanced cancer patients and their families requires prioritizing their specific communication needs and preferences. Evidence suggests that communication preferences regarding diagnosis and prognosis vary significantly across diverse cultural contexts. While Anglophone countries (e.g., the U.S.) prioritize full disclosure, physicians in Latin and Mediterranean cultures (e.g., Latin America, Spain, Italy) often withhold cancer diagnoses and prognoses from patients. Yet data are limited regarding preferences for diagnostic and prognostic information among older U.S. Latinos with advanced cancer and their families, a fast-growing demographic. Addressing communication disparities among Latinos that transcend language barriers and include cultural nuances is essential to eliminating inequities in health outcomes. The aim of this study was to examine variations in communication and disclosure preferences among older U.S. Latino and white patients with advanced cancer.

Methods: Participants consisted of 91 Latino and white advanced cancer patients aged 65 or older who were interviewed using a 45 to 60-minute questionnaire. We assessed disclosure and communication preferences using the 46-item Measure of Patients’ Preferences (MPP), covering the content, style, and timing of bad news conversations. Each item was assessed for importance using a five-point Likert scale, ranging from 1 (Not at all important) to 5 (Essential). Analyses of variance (ANOVA) identified ethnic mean differences in MPP items, while factor analysis examined item grouping and the concordance of factor structures between groups. All analyses were performed using IBM SPSS Statistics v31.0.

Results: In this sample of advanced cancer patients (mean age 72 years), 61% were Latino and 39% white. ANOVAs identified statistically significant ethnic differences in 15 MPP items (p < 0.05). The highest rated MPP item for Latino patients was, “Having the doctor be honest with me about the severity of my condition” (M = 4.25), while for white patients, the highest rated item was “Feeling confident about my doctor’s technical competence and skill” (M = 4.51). In general, Latino patients tended to prioritize supportive physician elements, such as having a doctor who knows them well, whereas white patients favored the content and style of communication delivery, such as receiving information promptly. Factor analyses suggested further distinct preference differences across ethnic groups.

Conclusion and Implications: The findings of this study have important implications for advancing culturally responsive oncology care among older U.S. Latino populations. By identifying differences in communication and disclosure preferences, the results challenge a universal model of “best practice” and instead support a more nuanced, patient-centered approach that integrates cultural values and trust-building. The prioritization of supportive physician characteristics among Latino patients underscores the need for clinicians to move beyond information delivery toward relationally attuned care that emphasizes empathy and connection. These insights can inform targeted communication training and clinical guidelines that better align with diverse patient preferences, ultimately improving patient satisfaction, treatment adherence, and quality of life in advanced cancer care. Moreover, the introduction of a validated Spanish-language Measure of Patients’ Preferences represents a methodological advancement, enabling more inclusive research and strengthening the foundation needed to reduce disparities in oncology outcomes.