It’s often your role as a healthcare professional to guide your patients in deciding whether or not to disclose their diagnosis at work. The major points to consider are:

WILL DIAGNOSIS OR TREATMENT INTERFERE WITH THEIR ABILITY TO PERFORM THE ESSENTIAL DUTIES OF THEIR JOB? If your patient is able to maintain productivity levels, attendance requirements, etc., then the ultimate decision of whether to disclose a cancer diagnosis is entirely up to them (they are generally not legally required to do so). For some, the degree of the disease and the prescribed course of treatment will be so severe that telling the employer may be a necessity in order to access legal protections. But even then, a patient may need to disclose only a fairly limited amount of information.

WHAT IS THEIR WORK ENVIRONMENT AND CULTURE? Some workplaces feel more open and receptive to employees sharing personal information. As such, it may feel “safe” for the patient to reveal a medical situation. In these types of environments, having a discussion early on with the employer may ultimately prove beneficial to the employee, even if your patient does not anticipate needing a reasonable accommodation.

It may be helpful to ask some leading questions to find out more about your patient’s work environment, such as:

• How long has your patient been employed at his/her company? This may help determine comfort level, what legal protections your patients are entitled to and their familiarity with the work culture over time. It may also help gauge the level of trust they have in their employer, which is often key in planning a disclosure conversation.
• What are their work relationships like? Is it a close-knit environment centered on teamwork? Do they trust and respect their boss, and vice versa? What other questions might help your patient understand the dynamics at play in their workplace?
• How has their work performance been evaluated prior to the diagnosis? This is an important point to explore. Perhaps the employee has had a poor performance history and they fear that disclosing the cancer would be the final straw for their employer. Patients should try to be truthful when assessing their standing at work.
• Have they witnessed other people at work going through a similar situation? For instance, when a colleague went out on maternity leave did the company rally around her and pitch in happily? Or was there displeasure at having to cover for her? Prior experiences can give patients a sense of what to anticipate.

WHAT IS THEIR INDIVIDUAL PERSONALITY AND HOW MIGHT THAT IMPACT SHARING THEIR DIAGNOSIS? It is important to assess the emotions your patients may be struggling with as they think through whether/how to disclose at work. Commonly, patients are most concerned about:

• Control: Patients may feel they are unable to control the course of the disease, but they may feel able to control the amount or type of information that is shared in their workplace. Making it their own decision may provide them with a sense of power during a time when they generally feel they have very little.
• Pity: Patients often say they fear that once they reveal their cancer diagnosis, they will become only a cancer patient in people’s eyes. Most patients want to avoid being seen in this light on the job, where they have an established role and image that is relative to their work — and has nothing to do with their health. They may fear discrimination — that people will interpret their illness as a diminishment of their abilities and will treat them differently.
• Vulnerability: By disclosing in the workplace, your patients may find they’ve unwittingly created an opening for other people to share their own stories, comments and connections to cancer. They are then forced to deal with their own emotions as well as their coworkers’ emotions, which can be overwhelming.

WHOM TO TELL. Patients who decide they want to disclose in the workplace should keep in mind that, depending on the size and structure of the company they work for, they may also have a decision to make regarding whom to speak with. In fact, in certain circumstances it may be necessary for a patient to have more than one disclosure conversation. Patients should carefully consider and plan out each conversation ahead of time, taking into account the professional role of the person they are speaking with and the relationship they have with that person:

• Supervisor: An immediate supervisor may be a good person to start the disclosure conversation with. Many patients discover that their boss turns out to be far more than just a manager. He/she can be a source of strength, hope and encouragement — even beyond the professional realm. A supervisor is also the person most knowledgeable about your patient’s workload and schedule, and understands how the team and company might best be able to support your patient. However, it is important to remember that not all supervisors are trained to be supervisors so they may not fully understand their role or legal responsibilities in supporting your patient. Encourage your patients to bring along a copy of our Managers Kit (which can be ordered or downloaded for free at https://www.cancerandcareers.org/publication_orders/new) to help guide any conversations.
• Human Resources Department: HR people can be fonts of information about their company’s policies. Most HR departments will have had experience with other employees who have had serious health conditions, in which case they can offer advice on how to tell coworkers and what to expect from the organization. However, not all patients will have access to an HR department or feel comfortable disclosing to them.
• Colleagues/Coworkers: When talking to his/her peers, suggest that your patient lets them know what he/she is likely to experience, such as fatigue or hair loss — then focuses on how he/she plans to cope.

WHAT TO TELL. Encourage patients to get as much information as possible from their doctors — including clear and detailed explanations of the diagnosis, the expected treatment, the prognosis and the anticipated timetable — before sharing the news at work. Gently remind patients that this information is very fluid — anything can change at anytime. The treatment, for instance, may take longer (or less time) than predicted or a different treatment plan may be adopted midcourse. Knowing this ahead of time — and communicating it to colleagues — can help your patients cope if any “curve balls” come their way.

Then, if possible, they should create an action plan for how their work will get done while they’re undergoing treatment. By having a plan in place, your patient communicates to others that he/she is continuing to take work responsibilities seriously. The plan should include things such as:

• Any outstanding projects
• How your patient plans to complete the work or who will cover for them
• Any reasonable accommodations they may potentially request.