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Gynecologic Oncology 9

Conference Report

Communication between patients and healthcare

providers in oncologyi

A cancer diagnosis is often unexpected and stressful.

During the period of diagnosis and treatment for cancer,

patients interact and communicate with multiple healthcare

providers. Communication in a provider patient network may

be important for the satisfaction of both patients and

providers.

Communication is multidimensional and involves both

the content of the discussion and the relationship aspects of

the interaction. The communication may serve many

purposes including exchanging information, creating a good

interpersonal and supportive relationship, and making me-

dical decisions. Communication is important throughout all

phase of the cancer trajectory including screening, diagnosis,

treatment, surveillance, recurrence, and the end of life.

Patients may have difficulty conveying understanding,

processing, and remembering complex medical information.

Patients may be reluctant to bring up certain topics with

their providers, especially psychosocial concerns. Providers

may be reluctant to inquire actively about patients’ reactions

and feelings. Providers may also have difficulty conveying

information in ways that patients’ best understand.

Research suggests that good communication skills are

associated with important outcomes of care. To date there

has been very little research about communication in

cervical cancer. The extent to which findings of other

studies can be applied to cervical cancer is unknown.

Effective healthcare provider–patient communication in

part involves information exchange about issues such as

medical history, symptoms, diagnosis, and prescribed treat-

ment. One conceptual framework that has been proposed is

seen in Fig. 1. This framework demonstrates the complexity

and dynamic nature of the communication process as well as

the importance of the context in which the communication

occurs. Information exchange is critical to effective provider–

patient communication, but it may also be the source of

considerable misunderstanding, sometimes called a commu-

nication gap.

A study that assessed the perceptions of patients and their

oncologists regarding important topics discussed in clinical

encounters will be presented in order to demonstrate some

doi:10.1016/j.ygyno.2005.07.064

i This report is based on a presentation given at the 4th International

Conference on Cervical Cancer.

communication challenges. In this study, patients with

cancers of unknown primary were recruited to participate.

These cancers present as metastatic diseased without a

definitive diagnosis of origin. Approximately 3–5% of all

cancers in the United States carry this diagnosis. After a

thorough evaluation, approximately 25% of patients have a

primary diagnosis.

The goal of the study was to examine physicians and

patients perceptions about what was discussed and their

beliefs about key aspects of their disease during initial

outpatient oncology visits. Patients were recruited from the

unknown primary clinic at M. D. Anderson. Each patient

signed an informed consent. Participants were recruited from

the waiting area prior to their medical visit. The visits were

audiotaped with the consent of all parties. Immediately

following the visit, the physician and patient completed a

brief questionnaire about the visit. Measures that were

collected included demographics, the patient checklist

(perceptions about what was discussed and beliefs about

cancer and treatment), and the physician checklist (percep-

tions about what was discussed and beliefs about cancer and

treatment).

Seventy-eight patients participated in the study. Patients

were on average 61 years old and 69% were male. Patients

were primarily Caucasian (90%) and 90% were married or

living with a partner. Thirty-one percent worked full-time

and 56% had a college degree or higher education.

Results of this study indicated there were discrepancies

in perceptions between patients and physicians regarding

the extent to which several topics were discussed as well as

9 (2005) S137–S138

Fig. 1. Conceptual framework for communication.

Fig. 2. Perceptions of what was discussed [Parker P, Baile W, Cohen L,

Heads A, Phan L, Lenzi R. Perception of what was discussed during

oncology visits: Do patients and physicians agree? Annals of Behavioral

Medicine 27 (suppl), S034, 2004].

Fig. 3. Beliefs about the disease process [Parker P, Baile W, Cohen L,

Heads A, Phan L, Lenzi R. Perception of what was discussed during

oncology visits: Do patients and physicians agree? Annals of Behavioral

Medicine 27 (suppl), S034, 2004].

Conference ReportS138

the content of those discussions. Figs. 2 and 3 demonstrate

the results pictorially.

Results indicated that patients and physicians had

significantly different perceptions regarding the extent of

discussions of the prognosis (P = 0.03) and the expected

efficacy of the proposed treatment (P = 0.04). Patients and

physicians reported similar perceptions regarding how much

supportive care (P N 0.10) and the probability of finding a

primary tumor (P = 0.06) were discussed. Following the

visit, patients and physicians differed in their estimates of the

efficacy of the proposed treatment (P b 0.001), but reported

similar expectations regarding whether the likelihood that

the primary tumor would be found (P N 0.10) and about the

patient’s life expectancy (P N 0.10). These study findings

have important implications for patients including their

understanding of their illness, the expectations they may

have about the efficacy of treatment interventions, and their

satisfaction with treatment. Immediately following the

consultation, there were discrepancies between the physi-

cians’ and patients’ perceptions. There appeared to be

greater discordance regarding perceptions about what was

discussed than beliefs about the cancer and its treatment. In

several areas, patients reported that topics were discussed

more extensively. Results have implications for how patients

understand information that is presented to them regarding

their cancer and expectations for proposed treatments. It is

unclear how the concordance and discordance influences

patients’ psychosocial adjustment. Developing educational

interventions to improve the communications may result in

greater understanding and better decision making and

perhaps improved patient outcome such as satisfaction and

quality of life.

Patricia A. Parker

M. D. Anderson Cancer Center,

Department of Behavioral Science, 1515 Holcombe Blvd.,

Unit 1330, Houston, TX 77030, USA

E-mail address: pparker@mdanderson.org.