P. N. Butow

The dynamics of change: Cancer patients' preferences for information, involvement and support

BACKGROUNDnWhile the importance of providing individualised communication to cancer patients is now well recognised, little is known about the stability and validity of patients expressed preferences for information and involvement in decision-making. This study explored the stability and possible predictors of such preferences over time.nnnPATIENTS AND METHODSnCancer patients seeing two Medical Oncologists in an out-patient clinic at an Australian teaching hospital completed a questionnaire battery before and directly after one consultation, and before their next consultation. Eighty consecutive patients with heterogeneous cancers participated in the study. Preferences for general and specific information, involvement and support were elicited at each assessment. Locus of control and patient familiarity with the clinic were measured before the first consultation. Patient satisfaction with the consultation was assessed directly after the consultation. Demographic and disease data were recorded for each patient.nnnRESULTSnGeneral preferences for information and involvement were relatively stable, at least in the short term; however there was considerable variability in preferences for specific topics of information. Patients whose condition had recently worsened were more likely to want progressively less involvement in decision-making. Gender, the doctor seen and religion were also predictive of patient preferences.nnnCONCLUSIONSnSituational factors, such as change in disease status, may alter a patients preferences for information and involvement. If we wish to match the provision of information and support to the expressed needs of patients, we must ask patients at each consultation what those needs are.

Promoting patient participation in the cancer consultation : evaluation of a prompt sheet and coaching in question-asking

Active participation in the medical consultation has been demonstrated to benefit aspects of patients’ subsequent psychological well-being. We investigated two interventions promoting patient question-asking behaviour. The first was a question prompt sheet provided before the consultation, which was endorsed and worked through by the clinician. The second was a face to face coaching session exploring the benefits of, and barriers to, question-asking, followed by coaching in question-asking behaviour employing rehearsal techniques. Sixty patients with heterogeneous cancers, seeing two medical oncologists for the first time, were randomly assigned to one of three groups: two intervention groups and one control group. Sociodemographic variables and anxiety were assessed prior to the intervention which preceded the consultation. The consultations were audiotaped and subsequently analysed for question-asking behaviour. Anxiety was assessed again immediately following the consultation. Questionnaires to assess patient satisfaction, anxiety and psychological adjustment were sent by mail 2 weeks following the consultation. Presentation and discussion of the prompt sheet significantly increased the total number of questions asked and the number of questions asked regarding tests and treatment. Coaching did not add significantly to the effects of the prompt sheet. Psychological outcomes were not different among the groups. We conclude that a question prompt sheet addressed by the doctor is a simple, inexpensive and effective means of promoting patient question asking in the cancer consultation.

Computer-based interaction analysis of the cancer consultation.

There are few data available on which to base recommendations for effective communication in the cancer consultation. This paper describes a computerised interaction analysis system designed specifically for the cancer consultation and its application in a study investigating the relationship between doctor-patient behaviour and patient outcomes. One hundred and forty-two cancer patients attending their first consultation with a cancer specialist were audio taped and a copy of the tape was retained for interaction analysis. Before the consultation patient anxiety and information and involvement preferences were measured. Outcomes included recall of information, patient satisfaction with the consultation and psychological adjustment to cancer. Doctor behaviour was shown to vary significantly according to the age, sex, involvement preferences and in/out-patient status of the patient. The ratio of doctor to patient talk was related to satisfaction with communication, while patients whose questions were answered showed better psychological adjustment at follow-up. The results suggest that patient-centred consultations lead to improved satisfaction and psychological adjustment. These data provide precise information about consultation behaviour which can be used in the documentation of current practice and the evaluation of new interventions to improve communication.

Misunderstanding in cancer patients: Why shoot the messenger?

AIMnWe aimed to document the prevalence of misunderstanding in cancer patients and investigate whether patient denial is related to misunderstanding.nnnPATIENTS AND METHODSnTwo hundred forty-four adult cancer outpatients receiving treatment completed a survey assessing levels of understanding and denial. Doctors provided the facts against which patient responses were compared. Multiple logistic regression analyses determined the predictors of misunderstanding.nnnRESULTSnMost patients understood the extent of their disease (71%, 95% CI: 65%-77%) and goal of treatment (60%, 95% CI: 54%-67%). Few correctly estimated the likelihood of treatment achieving cure (18%, 95% CI: 13%-23%), prolongation of life (13%, 95% CI: 8%-17%) and palliation (18%, 95% CI: 10%-27%). Patient denial predicted misunderstanding of the probability that treatment would cure disease when controlling for other patient and disease variables (OR = 2.20, 95% CI: 0.99-4.88, P = 0.05). Patient ratings of the clarity of information received were also predictive of patient understanding.nnnCONCLUSIONSnPatient denial appears to produce misunderstanding, however, doctors ability to communicate effectively is also implicated. The challenge that oncologists face is how to communicate information in a manner which is both responsive to patients emotional status and sufficiently informative to allow informed decision-making to take place.

Attitudes to randomized clinical trials amongst out‐patients attending a medical oncology clinic

Objectiveu2002To assess the understanding of and attitudes towards randomized clinical trials amongst patients attending oncology out‐patient clinics.

Meeting patient expectations in the cancer consultation

BACKGROUNDnLow scores on satisfaction measures may be anticipated when patients expectations of the doctor are unmet during the cancer consultation. We correlated discrepancies between patient expectations of their ideal doctor and their perceptions of their actual doctor with scores on a validated satisfaction scale to determine whether patients whose expectations were unmet were less satisfied.nnnPATIENTS AND METHODSnThe expectations questionnaire used a forced choice method designed to elicit patient preferences for either emotional or informational support from the physician. One hundred and five new patients with heterogeneous cancers, of five medical oncologists at a major teaching hospital were sampled. The patients were mostly female (55%) middle aged (mean age 54.3) and newly diagnosed with cancer (56% within two months prior to consultation).nnnRESULTSnPatients did not demonstrate a clear preference for an emotionally or informationally supportive approach. Seventy percent of patients did not want emotionally negative physicians but most (88.4%) would tolerate negative information. The mean number of exact matches between patients expectations of the ideal and their perceptions of their actual doctor was 3.7 (from a total of six). 5.9% of patients received exactly the doctor they wanted. No significant differences in satisfaction were found between patients whose expectations were met and those whose expectations were not met.nnnCONCLUSIONSnPatient satisfaction with the consultation was independent of patient expectation for informational or emotional support.

Cognitive processes in dieting disorders

This study is an empirical investigation of the prevailing notion that dieting disorder patients have more dysfunctional cognitions and cognitive styles than the nonclinical population. Groups of anorexics, bulimics, normal restrainers, and normal nonrestrainers completed three questionnaires and two repertory grids. Overall, the data supported a cognitive model of dieting disorders. Patients exhibited a lack of awareness of the role played by inner sensations in regulating weight and eating behavior, and emphasized black and white rules instead. Anorexic patients tended to evaluate self-worth almost entirely in terms of self-control. Both patient groups evidenced extreme negativity in their views of themselves, but anorexics showed a particularly severe sense of self-isolation. Unlike bulimics, they extended a tendency to think in absolute terms from the area of eating to the rest of their lives. Thus, the psychopathology of the anorexic patient group appeared more severe than that of bulimics.

Focus group interviews examining attitudes to randomised trials among breast cancer patients and the general community

Objective: To explore the knowledge of, and attitudes towards, randomised clinical trials among women in the community and breast cancer patients.

Meeting patients' information needs beyond the year 2000

Advances in information technology, and changing patient expectation in regard to provision of information and participation in clinical decisions are already influencing the cancer consultation. In future, the oncologists role will evolve further, and the cancer consultation beyond the year 2000 will be an opportunity for information relating to the particular patients circumstances to be presented according to the patients wishes. Patients desired input into clinical decisions will be respected, and consultation audiotapes will be a widely used aid for patients after the consultation.