Study Examines Communication Regarding Health-Related Quality of Life between Cancer Patients and Providers
Cancer is generally associated with multiple symptoms, diminished functional status, and adverse changes in a patient’s health-related quality of life (HRQOL). Because clinical trials involving cancer patients have shown that HRQOL predicts survival duration and other clinical outcomes, it has become a particularly important concept in cancer care. This study sought to describe the content and frequency of communication about HRQOL during outpatient encounters between oncologists and their patients with advanced cancer, particularly in relation to future treatment decisions and goals of care. Investigators analyzed data pertaining to HRQOL in a subset of audio recordings from the Study of Communication in Oncologist-Patient Encounters (SCOPE) Trial, a randomized controlled trial conducted from 2003 to 2008 in two large U.S. academic medical centers and one VAMC. The subset in this study included 37 oncologists, and 70 patients expected to die within one year or less.
Findings show that HRQOL discussions between oncologists and patients were common, but the emphasis was often on treatment (e.g., side effects) and symptoms (e.g., pain), even in patients with advanced disease. All provider/patient encounters included some talk of HRQOL, ranging from 3% to 75% of the total conversation, with the average HRQOL discussion taking up 25% of the conversation. An analysis of topics showed that 56% concerned treatment, 14% concerned disease, and 3% concerned testing. Talk of emotions, mental health, and psychological HRQOL was introduced into the conversations more frequently by patients than providers (59% vs. 41%) and occurred in only 9% of the audio segments. Spiritual HRQOL also was introduced into the conversations more frequently by patients than providers (75% vs. 25%), and was discussed in only 1% of all audio segments. The authors suggest that given the often intense emotional experience of patients with advanced cancer, oncologists may need to pay more attention to psychological, social, and spiritual HRQOL concerns.
Rodriguez K, Bayliss N, Alexander S, et al. How oncologists and their patients with advanced cancer communicate about health-related quality of life. Psycho-Oncology May 2010;19(5):490-499.
Drs. Rodriguez and Bayliss are part of HSR&D’s Center for Health Equity Research and Promotion in Pittsburgh, PA.