Patient participation in multidisciplinary tumor conferences in breast and gynecological cancer care: How patient-centered is the communication?

Interruptions in multidisciplinary tumor conferences with patient participation: A video interaction analysis

OBJECTIVE

To identify a) interruptions (secondary activities disrupting the workflow of the main task) occurring during case discussions in multidisciplinary tumor conferences (MTCs) with patient participation, and b) observable reactions among patients and healthcare professionals (HCPs).

METHODS

Within the non-interventional mixed-methods study PINTU, we video-recorded five case discussions during MTCs with patient participation at one breast and gynecological cancer center. A qualitative sequential video interaction analysis was used to identify interruptions and related interactions.

RESULTS

Occurring interruptions resulted in reactions of patients and/or HCPs. Work organization and seating arrangement led to interruptions, e.g., turning around to face individuals. Some interruptions caused reactions only among patients and not among HCPs.

CONCLUSION

Interruptions occur regularly in case discussions during MTCs with patient participation. Certain interruptions, which did not cause observable reactions among HCPs and seem to be commonplace, attracted the patient's attention. As interruptions can be associated with patients' unmet need for information, HCPs' awareness of interruptions should be raised.

PRACTICE IMPLICATIONS

When patients participate in MTCs, interruptions should be reduced to improve HCP-patient interactions. Our findings can lead to recommendations for improving organization of MTCs with patient participation aiming to cause fewer interruptions and thus better quality of patient care.

Clinician responses to emotions and patient experience: A response to Kuchinad et al (2024)

In a recent article, research on clinician responses to emotions and patient ratings of communication is presented. In the discussion section, the authors refer to results from a multidisciplinary research team including the authors of this correspondence. The results of both studies differ in some respects: A closer look at the methodology and the results could help to better understand these different results.

Which clinician responses to emotion are associated with more positive patient experiences of communication?

OBJECTIVES

To identify communication strategies that may improve clinician-patient interactions, we assessed the association between clinician response to emotion and patient ratings of communication.

METHODS

From a cohort of 1817 clinician-patient encounters, we designed a retrospective case-control study by identifying 69 patients who rated their interpersonal care as low-quality and 69 patients who rated their care as high-quality. We used the Verona Coding Definitions of Emotional Sequences (VR-CoDES) to identify patient emotional expressions and clinician responses. Using mixed-effects logistic regression, we evaluated the association between clinician responses to patients' emotions and patient ratings of their interpersonal care.

RESULTS

In adjusted analyses, explicit responses that reduced space for further emotional communication were associated with high ratings of care (OR 1.94, 95% CI 1.25, 2.99); non-explicit responses providing additional space were associated with low ratings (OR 0.54, 95% CI 0.36-0.82). In terms of specific response types, neutral/passive responses were associated with low ratings (OR 0.59, 95% CI 0.39-0.90), whereas giving information/advice was associated with high ratings (OR, 95% 1.91 CI 1.17-3.1).

CONCLUSIONS

Patients may prefer responses to their expressed emotions that demonstrate clinician engagement, with or without expressions of empathy.

PRACTICE IMPLICATIONS

These findings may inform educational interventions to improve clinician-patient communication.

Treatment confidence and patient participation in multidisciplinary tumor conferences: A structural equation modeling approach

OBJECTIVE

Multidisciplinary tumor conference (MTC) is a key instrument in multidisciplinary cancer care. In recent years, if and how patient participation in MTC can contribute to a more patient-centered care have been scientifically discussed. This study aimed to identify determinants of treatment confidence in the context of patient participation in MTC. Therefore, the association among health literacy-sensitive communication, trust in health-care providers (HCP), and treatment confidence is examined.

METHODS

This study used data from the multicenter, observational study "PINTU" on patient participation in MTC. Data were collected from November 2018 to February 2020. Validated scales for treatment confidence, health literacy-sensitive communication, and trust in providers were included in the structural equation modeling (SEM) analysis.

RESULTS

A total of 95 patients participated in MTC. The sample compromised n = 80 completed datasets. The SEM fit measures indicated good fit of the proposed model. The analysis showed a positive association between health literacy-sensitive communication and treatment confidence when adding the mediating effect of trust in providers.

CONCLUSION

Patient-centered communication during MTC in combination with a trustful relationship between participating patients and health-care providers is positively associated with treatment confidence. The results indicated the relevance of a trustful doctor-patient communication and relationship. Trainings for physicians targeting patient-centered communication could be a promising approach to strengthen patient participation.