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Lund CM, Mikkelsen MK, Theile S, Michelsen HM, Schultz M, Sengeløv L, Nielsen DL. Age-related Differences in Recall of Information and Handling of Chemotherapy-related Side Effects in Cancer Patients: The ReCap Study. Oncologist 2022; 27:e185-e193. [PMID: 35641212 PMCID: PMC8895734 DOI: 10.1093/oncolo/oyab034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/23/2021] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
To prevent severe toxicity and hospital admissions, adequate management and recall of information about side effects are crucial and health literacy plays an important role. If age-related factors impact recall of given information and handling of side effects, revised ways to give information are required.
Patients and Methods
We undertook a questionnaire-based survey among 188 newly diagnosed patients with pancreatic cancer or colorectal cancer and chemo-naive patients with prostate cancer treated with adjuvant or first-line palliative chemotherapy comprising satisfaction with given information, recall of potential side effects, and handling of hypothetical side effect scenarios. We evaluated the association between baseline characteristics, ie, age, frailty (G8 score), comorbidity (Charlson Comorbidity Index), cognitive function (Mini-Cog), satisfaction, recall of information, and handling of side effects.
Results
Reduced ability to recall information about several side effects (eg, chest pain) was associated with older age (odds ratio adjusted for cancer [aOR] 0.94 [95% CI, 0.88-0.98]) and poor cognitive screening (aOR 0.56 [95% CI, 0.33-0.91]). Insufficient or dangerous handling of side effects was associated with older age (aOR 0.96 (95% CI, 0.92-0.99)) and cognitive impairment (aOR 0.70 [95% CI, 0.50-0.95]).
Conclusion
Older age and poor cognitive screening may impact patients’ ability to understand and adequately handle chemotherapy-related side effects. Cognitive screening and focus on individual ways to give information including assessment of recall and handling are needed.
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Affiliation(s)
- Cecilia Margareta Lund
- Department of Medicine, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
- CopenAge, Copenhagen Center for Clinical Age Research, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - M K Mikkelsen
- Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Copenhagen, Denmark
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - S Theile
- Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - H M Michelsen
- Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - M Schultz
- Department of Medicine, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
- CopenAge, Copenhagen Center for Clinical Age Research, University of Copenhagen, Copenhagen, Denmark
| | - L Sengeløv
- Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - D L Nielsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
- Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Copenhagen, Denmark
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Lafaro KJ, Li A, Rodriguez J, Clark K, Loscalzo M, Wong FL, Melstrom LG, Warner SG. Surgeon and patient perceptions of cure in advanced gastrointestinal malignancies: Are we on the same page? J Surg Oncol 2020; 122:489-494. [PMID: 32441359 DOI: 10.1002/jso.25986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/09/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES Effective communication is essential to complex shared decision making and is associated with improved recovery and pain control. However, patients and surgeons often have disparate expectations of treatment efficacy and perceptions of cure for advanced malignancies. This study measures correlation of patient and surgeon expectations with perceptions of cure. METHODS Our prospective study surveying surgeon-patient dyads before and after surgical consultation was performed for advanced abdominal malignancy between July and November 2017 at a single NCI designated cancer center using electronic questionnaires. RESULTS Patients and surgeons' own opinions regarding surgical candidacy (Q1), chance at cure (Q2), and life expectancy (Q3) did not measurably change from pre- to postvisit survey as evidenced by unchanged response concordance (patients Q1 P = .82; Q2 P = .81; and Q3 P = .53; surgeon responses Q1: P = .17; Q2: P = .32; and Q3: P = .50). Patient and surgeon perception of likelihood of cure and of estimated life expectancy remained discordant in pre- and postvisit surveys (Q2: P = .006 and Q3: P = .03). CONCLUSIONS These data highlight the stark differences between patient and surgeon perceptions of cure and prognosis of gastrointestinal cancers. These results prove that a larger scale study using this electronic questionnaire is feasible and important to better understand these differences and enhance shared decision making.
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Affiliation(s)
- Kelly J Lafaro
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Arthur Li
- Department of Population Sciences, City of Hope National Medical Center, Duarte, California
| | - Jenny Rodriguez
- Department of Supportive Care Medicine, City of Hope National Medical Center, Duarte, California
| | - Karen Clark
- Department of Supportive Care Medicine, City of Hope National Medical Center, Duarte, California
| | - Matthew Loscalzo
- Department of Supportive Care Medicine, City of Hope National Medical Center, Duarte, California
| | - F Lennie Wong
- Department of Population Sciences, City of Hope National Medical Center, Duarte, California
| | - Laleh G Melstrom
- Department of Surgery, City of Hope National Medical Center, Duarte, California
| | - Susanne G Warner
- Department of Surgery, City of Hope National Medical Center, Duarte, California
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Melis P, Galletta M, Gonzalez CIA, Contu P, Herrera MFJ. Ethical perspectives in communication in cancer care: An interpretative phenomenological study. Nurs Ethics 2020; 27:1418-1435. [PMID: 32406310 DOI: 10.1177/0969733020916771] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In cancer care, many clinical contexts still lack a good-quality patient-health professional communication about diagnosis and prognosis. Information transmission enables patients to make informed choices about their own healthcare. Nevertheless, disclosure is still an ethically challenging clinical problem in cancer care. High-quality care can be achieved by understanding the perspectives of others. The perspective of patients, their caregivers, physicians and nurses have seldom been simultaneously studied. OBJECTIVE To investigate the phenomenon of diagnosis and prognosis-related communication as experienced by patients, their caregivers, and both their attending nurses and physicians, to enlighten meanings attached to communication by the four parties. METHODS A qualitative study using interpretative phenomenological analysis was performed. PARTICIPANTS AND RESEARCH CONTEXT Purposive sampling of six patients, six caregivers, seven nurses and five physicians was performed in two oncological hospitals in Italy. ETHICAL CONSIDERATIONS Local Ethics Committee approved the study. It was guided by the ethical principles of voluntary enrolment, anonymity, privacy and confidentiality. RESULTS Three main themes were identified: (a) the infinite range of possibilities in knowing and willing to know, (b) communication with the patient as a conflicting situation and (c) the bind of implicit and explicit meaning of communication. CONCLUSION The interplay of meanings attached by patients, their caregivers, and their attending oncologist and nurse to communication about diagnosis and prognosis revealed complexities and ambiguities not yet settled. Physicians still need to solve the ethical tensions in their caring relationship with patients to really allow them 'to choose with dignity and being aware of it'. Nurses need to develop awareness about their role in diagnosis and prognosis-related communication. This cognizance is essential not just to assure consistency of communication within the multi-disciplinary team but mostly because it allows and enables the moral agent to take its own responsibilities and be accountable for them.
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Affiliation(s)
- Paola Melis
- 3111University of Cagliari, Italy.,16777Universitat Rovira i Virgili, Spain
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4
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Bol N, Smets EMA, Burgers JA, Samii SM, De Haes HCJM, Van Weert JCM. Older Patients' Recall of Online Cancer Information: Do Ability and Motivation Matter More than Chronological Age? JOURNAL OF HEALTH COMMUNICATION 2017; 23:9-19. [PMID: 29227736 DOI: 10.1080/10810730.2017.1394400] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study proposes and tests a model to provide a more comprehensive understanding of the contribution of chronological age versus age-related ability and motivation factors in explaining recall of online cancer information among older patients (n = 197). Results revealed that recall is not a matter of chronological age per se, but rather a matter of ability and motivation. Age-related ability and motivation factors explained 37.9% of the variance in recall. Health literacy, involvement with the webpage, and satisfaction with the emotional support were positively associated with recall. Furthermore, recall was negatively related to frailty, anger, future time perspective, and perceived cognitive load. The findings pose relevant opportunities for tailoring interventions to improve online information provision for older cancer patients.
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Affiliation(s)
- Nadine Bol
- a Amsterdam School of Communication Research , University of Amsterdam , Amsterdam , The Netherlands
| | - Ellen M A Smets
- b Department of Medical Psychology , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
| | - Jacobus A Burgers
- c Department of Thoracic Oncology , The Netherlands Cancer Institute , Amsterdam , The Netherlands
| | - Suzy M Samii
- d Department of Pulmonology , Deventer Hospital , Deventer , The Netherlands
| | - Hanneke C J M De Haes
- b Department of Medical Psychology , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
| | - Julia C M Van Weert
- a Amsterdam School of Communication Research , University of Amsterdam , Amsterdam , The Netherlands
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5
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Manning M, Albrecht TL, Yilmaz-Saab Z, Shultz J, Purrington K. Influences of race and breast density on related cognitive and emotion outcomes before mandated breast density notification. Soc Sci Med 2016; 169:171-179. [PMID: 27733299 PMCID: PMC6816018 DOI: 10.1016/j.socscimed.2016.09.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/22/2016] [Accepted: 09/26/2016] [Indexed: 10/20/2022]
Abstract
RATIONALE Many states have adopted laws mandating breast density (BD) notification for applicable women; however, very little is known about what women knew or felt about BD and related breast cancer (BC) risk before implementation of BD notification laws. OBJECTIVE We examined between-race differences in the extent to which having dense breasts was associated with women's related BD cognition and emotion, and with health care providers' communication about BD. METHODS We received surveys between May and October of 2015 assessing health care provider (HCP) communication about BD, BD-related knowledge, BD-related anxiety and BC worry from 182 African American (AA) and 113 European American (EA) women in the state of Michigan for whom we had radiologists' assessments of BD. RESULTS Whereas having dense breasts was not associated with any BD-related cognition or emotion, there were robust effects of race as follows: EA women were more likely to have been told about BD by a HCP, more likely to know their BD status, had greater knowledge of BD and of BC risk, and had greater perceptions of BC risk and worry; AA women had greater BD-related anxieties. EA women's greater knowledge of their own BD status was directly related to the increased likelihood of HCP communication about BD. However, HCP communication about BD attenuated anxiety for AA women only. CONCLUSION We present the only data of which we are aware that examines between-race differences in the associations between actual BD, HCP communication and BD related cognition and emotion before the implementation of BD notification laws. Our findings suggest that the BD notification laws could yield positive benefits for disparities in BD-related knowledge and anxiety when the notifications are followed by discussions with health care providers.
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Affiliation(s)
- Mark Manning
- Karmanos Cancer Institute, Wayne State University School of Medicine, 4100 John R Rd, Detroit, MI 48201, United States.
| | - Terrance L Albrecht
- Karmanos Cancer Institute, Wayne State University School of Medicine, 4100 John R Rd, Detroit, MI 48201, United States
| | - Zeynep Yilmaz-Saab
- Karmanos Cancer Institute, Wayne State University School of Medicine, 4100 John R Rd, Detroit, MI 48201, United States
| | - Julie Shultz
- Karmanos Cancer Institute, Wayne State University School of Medicine, 4100 John R Rd, Detroit, MI 48201, United States
| | - Kristen Purrington
- Karmanos Cancer Institute, Wayne State University School of Medicine, 4100 John R Rd, Detroit, MI 48201, United States
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Pieterse AH, Kunneman M, Engelhardt EG, Brouwer NJ, Kroep JR, Marijnen CAM, Stiggelbout AM, Smets EMA. Oncologist, patient, and companion questions during pretreatment consultations about adjuvant cancer treatment: a shared decision-making perspective. Psychooncology 2016; 26:943-950. [PMID: 27502561 DOI: 10.1002/pon.4241] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 06/17/2016] [Accepted: 07/27/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To assess the occurrence of questions that foster shared decision making, in particular cancer patients' understanding of treatment decisions and oncologists' understanding of patients' priorities, during consultations in which preference-sensitive decisions are discussed. Specifically, (a) regarding patient understanding, do oncologists ask about patients' preexisting knowledge, information preferences, and understanding and do patients and companions ask about the disease and treatment, and (b) regarding patient priorities, do oncologists ask about patients' treatment- and decision-related preferences and do patients and companions ask about the decision? METHODS Audiotaped pretreatment consultations of 100 cancer patients with 32 oncologists about (neo)adjuvant treatment were coded and analyzed to document question type, topic, and initiative. RESULTS The oncologists ascertained prior knowledge in 50 patients, asked 24 patients about preferred (probability) information, and invited questions from 56 patients. The oncologists asked 32 patients about treatment preferences and/or for consent. Respectively, one-third and one-fifth of patients and companions asked about treatment benefits compared with three-quarters of them who asked about treatment harms and/or procedures. CONCLUSIONS It would be helpful to patients if oncologists more often assessed patients' existing knowledge to tailor their information provision. Also, patients could receive treatment recommendations that better fit their personal situation if oncologists collected information on patients' views about treatments. Moreover, by educating patients to ask about treatment alternatives, benefits, and harms, patients may gain a better understanding of the choice they have.
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Affiliation(s)
- A H Pieterse
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - M Kunneman
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.,Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
| | - E G Engelhardt
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - N J Brouwer
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - J R Kroep
- Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - C A M Marijnen
- Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - A M Stiggelbout
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - E M A Smets
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
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Johnson M, Tod AM, Brummell S, Collins K. Prognostic communication in cancer: A critical interpretive synthesis of the literature. Eur J Oncol Nurs 2015; 19:554-67. [DOI: 10.1016/j.ejon.2015.03.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 02/28/2015] [Accepted: 03/04/2015] [Indexed: 10/23/2022]
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8
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Hird AE, Lemke M, Turovsky M, Malecki V, Kumar K, DeAngelis C, Chow E, Ko YJ. Doctor, what are my options? A prospective cohort study of an individualized care plan for patients with gastrointestinal cancer. ACTA ACUST UNITED AC 2015; 22:e171-7. [PMID: 26089728 DOI: 10.3747/co.22.2194] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND For cancer patients, information about their disease and its treatment is often delivered within a short time period, potentially leading to patient misunderstanding, which can impede optimal patient care. In this 3-part clinical study, we investigated the utility of an individualized care plan for patients with gastrointestinal (gi) cancer starting a new treatment. METHODS In part 1, a comprehensive literature search identified items for potential inclusion in the care plan. Those items were formatted into a questionnaire. The questionnaire was then administered to patients as a structured interview. In part 2, health care professionals involved in the care of patients with gi cancer evaluated the resulting care plan for content and relevancy. In part 3, a 20-week prospective cohort study (10 weeks using standard of care, 10 weeks using individualized care plans) was conducted. Outcomes were assessed at baseline and at 2-4 weeks after administration of the care plan. RESULTS In part 1, a 73-item questionnaire was developed and completed by 20 patients in semi-structured interviews. In part 2, long and short versions of the care plan were created. Most health care professionals preferred the long version. Based on their comments, a final version of the care plan was created. The part 3 study enrolled 104 patients. Overall satisfaction scores were significantly higher in the intervention group at baseline (p = 0.010) and follow-up (p = 0.005). Compared with control patients, the intervention cohort also reported significantly higher overall quality of life (p = 0.044) and fewer symptoms of anxiety (p = 0.048) at follow-up. CONCLUSIONS Provision of an individualized care plan resulted in improvements in outcome measures at both baseline and follow-up. Future studies are needed to confirm these findings.
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Affiliation(s)
- A E Hird
- Division of Medical Oncology and Hematology, Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, ON
| | - M Lemke
- Division of Medical Oncology and Hematology, Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, ON
| | - M Turovsky
- Division of Medical Oncology and Hematology, Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, ON
| | - V Malecki
- Division of Medical Oncology and Hematology, Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, ON
| | - K Kumar
- Division of Medical Oncology and Hematology, Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, ON
| | - C DeAngelis
- Department of Pharmacy, Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, ON
| | - E Chow
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, ON
| | - Y J Ko
- Division of Medical Oncology and Hematology, Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, ON
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9
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Bol N, van Weert JCM, de Haes HCJM, Loos EF, Smets EMA. The effect of modality and narration style on recall of online health information: results from a Web-based experiment. J Med Internet Res 2015; 17:e104. [PMID: 25910416 PMCID: PMC4425819 DOI: 10.2196/jmir.4164] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 03/03/2015] [Indexed: 11/13/2022] Open
Abstract
Background Older adults are increasingly using the Internet for health information; however, they are often not able to correctly recall Web-based information (eHealth information). Recall of information is crucial for optimal health outcomes, such as adequate disease management and adherence to medical regimes. Combining effective message strategies may help to improve recall of eHealth information among older adults. Presenting information in an audiovisual format using conversational narration style is expected to optimize recall of information compared to other combinations of modality and narration style. Objective The aim of this paper is to investigate the effect of modality and narration style on recall of health information, and whether there are differences between younger and older adults. Methods We conducted a Web-based experiment using a 2 (modality: written vs audiovisual information) by 2 (narration style: formal vs conversational style) between-subjects design (N=440). Age was assessed in the questionnaire and included as a factor: younger (<65 years) versus older (≥65 years) age. Participants were randomly assigned to one of four experimental webpages where information about lung cancer treatment was presented. A Web-based questionnaire assessed recall of eHealth information. Results Audiovisual modality (vs written modality) was found to increase recall of information in both younger and older adults (P=.04). Although conversational narration style (vs formal narration style) did not increase recall of information (P=.17), a synergistic effect between modality and narration style was revealed: combining audiovisual information with conversational style outperformed combining written information with formal style (P=.01), as well as written information with conversational style (P=.045). This finding suggests that conversational style especially increases recall of information when presented audiovisually. This combination of modality and narration style improved recall of information among both younger and older adults. Conclusions We conclude that combining audiovisual information with conversational style is the best way to present eHealth information to younger and older adults. Even though older adults did not proportionally recall more when audiovisual information was combined with conversational style than younger adults, this study reveals interesting implications for improving eHealth information that is effective for both younger and older adults.
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Affiliation(s)
- Nadine Bol
- Amsterdam School of Communication Research / ASCoR, Department of Communication Science, University of Amsterdam, Amsterdam, Netherlands.
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Goff SL, Mazor KM, Ting HH, Kleppel R, Rothberg MB. How cardiologists present the benefits of percutaneous coronary interventions to patients with stable angina: a qualitative analysis. JAMA Intern Med 2014; 174:1614-21. [PMID: 25156523 PMCID: PMC4553927 DOI: 10.1001/jamainternmed.2014.3328] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
IMPORTANCE Patients with stable coronary artery disease (CAD) attribute greater benefit to percutaneous coronary interventions (PCI) than indicated in clinical trials. Little is known about how cardiologists' presentation of the benefits and risks may influence patients' perceptions. OBJECTIVES To broadly describe the content of discussions between patients and cardiologists regarding angiogram and PCI for stable CAD, and to describe elements that may affect patients' understanding. DESIGN, SETTING, AND PARTICIPANTS Qualitative content analysis of encounters between cardiologists and patients with stable CAD who participated in the Verilogue Point-of-Practice Database between March 1, 2008, and August 31, 2012. Transcripts in which angiogram and PCI were discussed were retrieved from the database. Patients were aged 44 to 88 years (median, 64 years); 25% were women; 50% reported symptoms of angina; and 6% were taking more than 1 medication to treat angina. MAIN OUTCOMES AND MEASURES Results of conventional and directed qualitative content analysis. RESULTS Forty encounters were analyzed. Five major categories and subcategories of factors that may affect patients' understanding of benefit were identified: (1) rationale for recommending angiogram and PCI (eg, stress test results, symptoms, and cardiologist's preferences); (2) discussion of benefits (eg, accurate discussion of benefit [5%], explicitly overstated benefit [13%], and implicitly overstated benefit [35%]); (3) discussion of risks (eg, minimization of risk); (4) cardiologist's communication style (eg, humor, teach-back, message framing, and failure to respond to patient questions); and (5) patient and family member contributions to the discussion. CONCLUSIONS AND RELEVANCE Few cardiologists discussed the evidence-based benefits of angiogram and PCI for stable CAD, and some implicitly or explicitly overstated the benefits. The etiology of patient misunderstanding is likely multifactorial, but if future quantitative studies support the findings of this hypothesis-generating analysis, modifications to cardiologists' approach to describing the risks and benefits of the procedure may improve patient understanding.
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Affiliation(s)
- Sarah L Goff
- Department of Internal Medicine, Tufts University School of Medicine/Baystate Medical Center, Springfield, Massachusetts2The Center for Quality of Care Research, Tufts University School of Medicine/Baystate Medical Center, Springfield, Massachusetts
| | - Kathleen M Mazor
- Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester
| | - Henry H Ting
- Division of Cardiovascular Diseases, Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
| | - Reva Kleppel
- Department of Internal Medicine, Tufts University School of Medicine/Baystate Medical Center, Springfield, Massachusetts
| | - Michael B Rothberg
- Department of Internal Medicine, Cleveland Clinic Medicine Institute, Cleveland, Ohio
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