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Longitudinal Analysis of Patient-Physician Communication

Background

Patient-reported outcomes (PROs) of health-related quality of life (HRQoL) issues can give valuable feedback to oncologists and health care providers (HCPs) caring for patients with cancer (Takeuchi et al., 2011).  When collected on a routine basis, this information can help HCPs understand patients’ perspectives on the cancer experience and treatment as well as the impact of disease and its therapy on their HRQoL.  These outcome measures are responsive to clinical changes and the measures help to describe what the patient has actually experienced as the result of the medical care they have received (Wilson & Cleary, 1995).  This feedback could help HCPs better understand the unmet needs or problems of this population of patients, thus prompting HCPs to open discussion on these subjects, facilitating patient-centered communication and care (Takeuchi et al., 2011).  Previous research has demonstrated that regular PRO feedback to oncologists during cancer therapy produced better communication and improved patient well-being (Velikova et al., 2004).  Takeuchi and colleagues (2011) wished to examine the impact of PRO feedback on patient-physician communication over time with the intent of investigating whether repeated PRO interventions had a longitudinal impact on patient-physician communication and whether PRO feedback encouraged oncologists to initiate discussion of HRQoL issues.  The researchers also aimed to determine the association between severity of patient-reported problems and clinic discussions.

Study Facts

  • Exploratory analyses were performed on a data set from a previous study
  • Patients randomly assigned to intervention (regular completion of European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 and Hospital Anxiety and Depression Scale with feedback to oncologists; attention-control (completions of same questionnaires without feedback); and control (standard care) arms
  • 28 oncologists and 198 patients over four consecutive visits (comprising 792 consultations) were analyzed for the study; all audio-recorded patient-physician consultations were subject to content analysis
  • Mixed-effects models and multivariate regressions were used to examine the longitudinal impact of the intervention on patient-physician communication, dynamics of patient-physician interaction, and the association between PROs and content of clinic discussion
  • Results demonstrated that patients in the intervention group discussed more symptoms over time in comparison to the attention-control  (P = .008) and control (P = .04) arms
  • Discussion topics were mostly raised by patients and their relatives, regardless of study arm
  • Interestingly, clinic discussions occurred in concert with the severity of patient-reported symptoms versus patient-reported functional concerns

Takeuchi and colleagues (2011) concluded that a positive longitudinal impact of the study intervention on symptom discussion was observed, as opposed to function discussion.  These results suggest that potentially serious problems are not always addressed by oncologists; oncologists trained in responding to patient-reported functional concerns could improve the impact of the study intervention.

ManageCRC Commentary

This study adds to the body of literature on patient-physician communication and the effect of PROs on HRQoL issues.  Interestingly, the discussion of symptoms remains consistent with the patients’ self-reported severity; although the intervention was supposed to alert the oncologists to patients and their problems, most symptom discussions were initiated by patients or their families.  The feedback from the PROs did not noticeably affect the patient-physician communication.  The study did demonstrate that the disease of cancer and its therapy does have an impact on patients’ HRQoL; however, although there is increased awareness of the importance of communication in the health care setting, the PRO feedback did not have an impact on patient function.  Various reasons may exist for the lack of improved patient-physician communication; the authors of the study note that time constraints, oncologist preferences and their ability to discuss psychosocial issues may play a role.  It would be interesting to repeat this study with oncology nurses versus oncologists to determine communication efforts for both physical symptoms and function in patients undergoing cancer therapy.  Increased training of oncologists and HCPs caring for patients with cancer may help to improve communication, thus allowing HCPs to better understand the impact of cancer and therapy on patient symptoms and function.

References

Takeuchi, E.E., Keding, A., Awad, N., Hofmann, U., Campbell, L.J., Selby, P.J., …Velikova, G. (2011).  Impact of patient-reported outcomes in oncology: A longitudinal analysis of patient-physician communication. Journal of Clinical Oncology, 29 (21), 2910-2917. doi: 10.1200/JCO.2010.32.2453  Link to abstract: http://www.ncbi.nlm.nih.gov/pubmed?term=takeuchi%2C%20velikova

Velikova, G., Booth, L., Smith, A.B., Brown, P.M., Lynch, P., Brown, J.M.,…Selby, P.J. (2004).  Measuring quality of life in routine oncology practice improves communication and patient well-being: A randomized controlled trial. Journal of Clinical Oncology, 22 (4), 714-724. doi: 10.1200/JCO.2004.06.078 Free full text available: http://jco.ascopubs.org/content/22/4/714.full.pdf+html

Wilson, I.B. & Cleary, P.D. (1995). Linking clinical variables with health-related quality of life. The Journal of the American Medical Association, 273 (1), 59-65. Free full text available:  http://jama.ama-assn.org/content/273/1/59.full.pdf+html

 



Article Created On : 8/5/2011 8:48:51 AM             Article Updated On : 8/5/2011 8:48:51 AM