Physician Communication in a Lung Cancer Center – Does the Message Come Across?

Abstract

Objective: Lung cancer patients require information about their diagnosis, treatment procedure and the treatment goal. We have examined recall of patients and how satisfied they were with physician communication.

Patients and Methods: 101 patients with newly diagnosed lung cancer were interviewed shortly after the disclosure of diagnosis about their diagnosis, treatment procedure and treatment goal. Disclosing physicians were asked what information they had given. Physician information and patient recall was then compared.

Results: Eighty-six percent (86 of 100 patients) knew their diagnosis, 81 % recalled the treatment procedure correctly, and 42 % knew if the treatment goal was curative or palliative. We found high satisfaction about communication of diagnosis and treatment procedure (83 % resp. 77 %). However, satisfaction with communication of the treatment goal was 53 % (51 of 97 patients) and significantly lower than satisfaction with communication of diagnosis and of treatment procedure. Patients who were informed by male physicians were significantly more satisfied with the disclosure about the treatment goal.

Conclusions: Treatment goals are difficult to convey by untrained physicians. Further research is needed to understand how we can improve patients’ understanding of and satisfaction with information about the treatment goal and prognosis and how physicians can improve their communication skills.

Zusammenfassung

Hintergrund: Lungenkrebspatienten benötigen eine umfassende Aufklärung über ihre Diagnose, die Behandlung und das Ziel der Behandlung. Wir haben untersucht, was Lungenkrebspatienten nach dem Aufklärungsgespräch erinnerten und wie zufrieden sie mit der ärztlichen Kommunikation waren.

Methodik: 101 Patienten mit neu diagnostiziertem Lungenkrebs wurden kurz nach der Aufklärung über die Diagnose, die Therapie und das Therapieziel zu dem ärztlichen Gespräch befragt. Die aufklärenden Ärzte wurden gebeten, den Inhalt des Aufklärungsgesprächs anzugeben. Die Antworten der Patienten und Ärzte wurden verglichen.

Ergebnisse: 86 % (86 von 100 Patienten) kannten ihre Diagnose, 81 % erinnerten den Therapievorschlag richtig und 42 % wussten, ob das Therapieziel kurativ oder palliativ war. Wir fanden eine hohe Zufriedenheit über die Kommunikation der Diagnose und der Therapie (83 % resp. 77 %). Die Zufriedenheit mit dem Gespräch über das Therapieziel war mit 53 % (51 von 97 Patienten) signifikant niedriger als die Zufriedenheit über die Kommunikation der Diagnose und der Therapie. Patienten, die von männlichen Ärzten aufgeklärt wurden, waren signifikant zufriedener mit dem Gespräch hinsichtlich des Therapieziels.

Schlussfolgerungen: Behandlungsziele sind schwer von Ärzten zu vermitteln, die in der Gesprächsführung nicht geschult sind. Weitere Untersuchungen sind notwendig, um zu verstehen, wie wir das Verständnis und die Zufriedenheit der Patienten mit der Kommunikation über das Therapieziel verbessern können.

• References

• 1 Fallowfield L. Giving sad and bad news. Lancet 1993; 341: 476-478
• 2 Schofield PE, Butow PN, Thompson JF et al. Psychological responses of patients receiving a diagnosis of cancer. Ann Oncol 2003; 14: 48-56
• 3 Butow PN, Maclean M, Dunn SM et al. The dynamics of change: cancer patients' preferences for information, involvement and support. Ann Oncol 1997; 8: 857-863
• 4 Fallowfield L, Jenkins V, Farewell V et al. Efficacy of a Cancer Research UK communication skills training model for oncologists: a randomised controlled trial. Lancet 2002; 359: 650-656
• 5 Schapira L, Butow P, Brown R et al. Pessimism is no poison. J Clin Oncol 2010; 28 : 705-707
• 6 Stewart M. What is a successful doctor patient interview? a study of interactions and outcomes. Soc Sci Med 1984; 19: 167-175
• 7 Lobb E, Butow P, Kenny D. Communicating prognosis in early breast cancer: do women understand the language used?. Med J Aust 1999; 171: 290-294
• 8 Quirt C, Mackillop W, Ginsburg A et al. Do doctors know when their patients don't? A survey of doctor–patient communication in lung cancer. Lung Cancer 1997; 18: 1-20
• 9 Gabrijel S, Grize L, Helfenstein E et al. Receiving the Diagnosis of Lung Cancer: Patient Recall of Information and Satisfaction With Physician Communication. J Clin Oncol 2008; 26 : 297-302
• 10 Sobin LH, Gospodarowicz MK, Wittekind C (eds.) International Union Against Cancer: TNM Classification of Malignant Tumours (ed. 7). West Sussex, United Kingdom: Wiley-Blackwell; 2009
• 11 Aaronson NK, Ahmedzai S, Bergman B et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 1993; 85: 365-376
• 12 Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67: 361-370
• 13 Keller M, Sommerfeldt S, Fischer C et al. Recognition of distress and psychiatric morbidity in cancer patients: a multi-method approach. Ann Oncol 2004; 15: 1243-1249
• 14 Taylor C, Graham J, Potts H et al. Changes in mental health of UK hospital consultants since the mid-1990s. Lancet 2005; 366 : 742-744
• 15 Parle M, Jones B, Maguire P. Maladaptive coping and affective disorders among cancer patients. Psychol Med 1996; 26 : 735-744
• 16 Bottomley A. Depression in cancer patients: a literature review. Eur J Cancer Care (Engl) 1998; 7: 181-191
• 17 Weeks JC, Catalano PJ, Cronin A et al. Patients' expectations about effects of chemotherapy for advanced cancer. N Engl J Med 2012; 367: 1616-1625
• 18 McCluskey L, Casarett D, Siderowf A. Breaking the news: a survey of ALS patients and their caregivers. Amyotroph Lateral Scler Other Motor Neuron Disord 2004; 5: 131-135
• 19 Yardley SJ, Davis CL, Sheldon F. Receiving a diagnosis of lung cancer: patients’ interpretations, perceptions and perspectives. Palliat Med 2001; 15: 379-386
• 20 Schildmann J, Brunklaus A, Herrmann E et al. Evaluation of a ‘breaking bad news’ course at the Charité, Berlin. Med Educ 2001; 35: 806-807
• 21 van Dalen J, Kerkhofs E, van Knippenberg-Van Den Berg BW et al. Longitudinal and concentrated communication skills programmes: two dutch medical schools compared. Adv Health Sci Educ Theory Pract 2002; 7: 29-40
• 22 Barrows HS. An overview of the uses of standardized patients for teaching and evaluating clinical skills. AAMC. Acad Med 1993; 68: 443-451 ; discussion 451-443
• 23 Baile WF, Lenzi R, Kudelka AP et al. Improving physician-patient communication in cancer care: outcome of a workshop for oncologists. J Cancer Educ 1997; 12: 166-173
• 24 Baile WF, Aaron J. Patient-physician communication in oncology: past, present, and future. Curr Opin Oncol 2005; 17: 331-335
• 25 Barth J, Lannen P. Efficacy of communication skills training courses in oncology: a systematic review and meta-analysis. Ann Oncol 2011; 22: 1030-1040
• 26 Weeks J, Cook E, O'Day S et al. Relationship between cancer patients’ predictions of prognosis and their treatment preferences. JAMA 1998; 279: 1709-1714
• 27 Thorne SE, Hislop TG, Stajduhar K et al. Time-related communication skills from the cancer patient perspective. Psychooncology 2009; 18: 500-507
• 28 Hagerty RG, Butow PN, Ellis PM et al. Communicating prognosis in cancer care: a systematic review of the literature. Ann Oncol 2005; 16: 1005-1053
• 29 Rogg L, Loge JH, Aasland OG et al. Physicians’ attitudes towards disclosure of prognostic information: a survey among a representative cross-section of 1605 Norwegian physicians. Patient Educ Couns 2009; 77: 242-247
• 30 Fumis R, De Camargo B, Del Giglio A. Physician, patient and family attitudes regarding information on prognosis: a Brazilian survey. Ann Oncol 2012; 23: 205-211
• 31 Epstein R, Hadee T, Carroll J et al. “Could this be something serious?” reassurance, uncertainty, and empathy in response to patients’ expressions of worry. J Gen Intern Med 2007; 22: 1731-1739
• 32 Hall JA, Blanch-Hartigan D, Roter DL. Patients’ satisfaction with male versus female physicians: a meta-analysis. Med Care 2011; 49: 611-617