Introduction Approximately 15,000 adolescents and young adults between 15 and 39 years of age are diagnosed with cancer each year in Germany [1]. The group of young adults in the age range of 18-39 years is characterized by specific physical and psychological challenges as well as personal developmental steps like education, starting a career, and family planning [2, 3] . Communication is an essential component of cancer care. Tailoring communication to the patient's specific needs and

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... es, particularly in delivering bad news, is crucial [4] . Buckman [5] defined bad news as 'any information which adversely and seriously affects an individual's view of his or her future'. There is a gap between the communication and information needs of young adult cancer patients and actual physician behavior, especially with regard to information on treatment side effects affecting sexual functioning and fertility [6, 7] . There are also discrepancies between patients' needs and experiences during follow-up care of young adults [8] . It is important that doctors and other healthcare professionals deliver cancer and treatment-related information that is age-appropriate and considers the personal development status of the individual [9, 10]. Little research has focused on how much the communicative needs of young adults are in concordance with perceived physician behavior when delivering bad news. Existing studies show that patients' needs were fulfilled only to a limited extent [11, 12] , particularly with regard to long-term effects such as fertility risks, reproductive options, or parenthood [13, 14] . The way in which bad news are delivered can have an impact on psychological adjustment and patient satisfaction with healthcare services [15, 16] . Also, ineffective or inappropriate communication can cause long-lasting distress and might even influence treatment outcomes [17, 18] . Summary Background: While psychosocial distress and supportive care needs of young adult cancer patients have been increasingly studied, little knowledge exists about preferences for communicating bad news. We aimed to analyze patients' communication preferences against their actual experiences with regard to doctor-patient interactions. Patients and Methods: We surveyed a total of 270 cancer patients with different tumor entities. 3 age groups (young, middle-aged, and elderly) were compared concerning their communication preferences (MPP; Measure of Patients' Preferences questionnaire) and the impact on distress (National Comprehensive Cancer Network Distress Thermometer). Results: We found no age differences of communication preferences and the content of bad news. A significant difference was found in the dimension 'professional expertise/patient orientation (p < 0.01) which was rated as more important by younger patients. Binary logistic regression showed an impact of 'children' (odds ratio (OR) 0.296; 95% confidence interval (CI) 0.155, 0.563), tumor staging (OR 1.737, 95% CI 1.028, 2.936), and insufficient 'privacy' (OR 0.987; 95% CI 0.978, 0.997) and 'clarity' (OR 1.013; 95% CI 1.002, 1.025) on distress. Conclusion: Communication preferences related to breaking bad news depend less on age differences than on other variables. Future studies should investigate the long-term impact of ineffective patient-physician communication, taking into account unmet patient preferences in different age groups.