What do Patients want from Their Radiation Oncologist? Final Results from a Prospective Randomized Trial

Reviewer: Christine Hill-Kayser, MD
Abramson Cancer Center of the University of Pennsylvania
Ultima Vez Modificado: 9 de noviembre del 2009

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Presenter: Ajay Batnagar
Presenter's Affiliation: Cancer Treatment Services International, Casa Grande, AZ
Type of Session: Scientific

Background

  • Adequate patient-physician relationships are very important for achieving good communication, and ultimately the best outcomes possible.
  • In the oncologic setting, physician guidance is essential as patients face life-altering decisions.
  • Although medical school training has come to incorporate more education regarding communication with patients, little formal study regarding patient preference has been performed or published, and may be difficult to execute.
  • The study described here was undertaken to analyze and report patient preferences for their radiation oncologists, and to determine whether patient satisfaction would be improved if radiation oncologists were apprised of their patient’s preferences.

Materials and Methods

  • This study was designed as a two-phase investigation with the intent of assessing the preferences of radiation oncology patients, and investigating whether knowledge of these preferences by radiation oncologists would impact patient satisfaction with treatment.
  • As the first study phase, focus groups of 25 male and 25 female cancer patients were established. The groups, together with medical and behavioral health specialists, designed a patient preference survey designed to assess the following issues:
    • Patient preference as to whether physicians address them by first versus last names
    • Patient preferences as to whether wearing of white coats by physicians, and wearing of professional clothing by physicians
    • Patient preference as to having their hands held at some point during a medical consultation.
    • Patient preference to be hugged by their physician at the end of a consultation or treatment course.
    • Patient preference that physicians explain treatments in detail.
    • Patient preference that physicians be honest about prognosis.
    • Patient preference that physicians use everyday language.
    • Patient preference that physicians discuss either patient religious beliefs or their own religious beliefs.
  • As the second study phase, patients with prostate, lung, or breast cancer being evaluated for need for radiotherapy at the University of Pittsburgh Cancer Institute’s Department of Radiation Oncology were enrolled on this IRB-approved randomized trial.
  • Patients were asked to complete preference surveys prior to their initial consultation with their physicians, midway through radiotherapy, and at completion of radiotherapy.
  • Patients were then randomized to either have their physicians blinded to their preferences, or to have them aware of their preferences.
  • Patients in both groups completed a satisfaction survey regarding their doctor-patient interactions at the completion of treatment.

Results

  • Between June, 2006 and March, 2008, a total of 811 patients were screened for participation in this study. Of these 508 were planned to receive radiation and participated in the study.
  • Median patient age was 64 years. Patients were 56% female, and 80% white.
  • The two groups were well-balanced with regard to demographics, with no statistically significant difference observed.
  • Selected patient preferences were as follows:
    • 72% of patients reported that they preferred to be called by their first names rather than their last.
      • This preference was greater among females than males (76% vs. 66%, respectively, p < 0.001).
      • This preference was also greater for white patients than black (74% vs. 56%, respectively, p = 0.012).
    • 80% of patients reported being neutral as to whether their physicians wore white coats.
    • A total of 95% of patients reported wanting their oncologist to be honest about their chances of cure and expected survival.
      • This preference was greater among prostate cancer patients than lung cancer patients (97% vs. 91%, p = 0.02).
    • More females than males reported desiring to have their hands held (37% vs. 12%, p < 0.001).
    • Patient desire to have treatment explained in everyday language appeared to correlate with patient education, with this desire expressed by 93% of patients having 8th grade education, 95% having high school education, 91% of patients having attending college, and 84% of patients with post-graduate education.
  • 98% of patients in both groups reported being highly satisfied at the completion of treatment.

Author's Conclusions

  • The authors conclude that several significant associations existed between certain patient demographics and their preferences, including use of hand-holding and everyday language.
  • They describe high levels of patient satisfaction regardless of wither or not physicians were made aware of patient-reported preferences.
  • They note that the results of this study may afford greater insight into patient preferences regarding their interactions with their radiation oncologists.

Clinical/Scientific Implications

  • The study described here represents a well-designed project, which is unique in its design and execution.
  • As the authors point out, its results may offer insight into the physician-patient relationship, foster adequate communication, and help direct hospital-wide policies regarding patient interactions.
  • Although the randomized portion of this study was negative in that it did not demonstrate improvement in patient satisfaction with physician awareness of patient preference, these results may be viewed as encouraging. Ideally, they imply that the medical community is aware of common patient preferences even without being explicitly told of them, and that patients may be provided with high levels of satisfaction based on their interactions with their physicians.
  • As clinicians, we may be mindful of the patient preferences delineated in this study. Further analysis will likely to continue to contribute to physicians efforts to promote excellent levels of patient satisfaction.

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