By Diana Swift, Medical Tribune News Service
TORONTO -- Though science and research may save a breast cancer
patient's life, her lifeline during treatment is communication.
Patients have strong needs for information and supportive,
communicative relationships with healthcare providers, both of
which can significantly affect their emotional health and possibly
health outcomes, said speakers on physician-patient communication
at a Toronto conference sponsored by the Canadian Breast Cancer
Research Initiative. Findings were also presented showing that the
way information was presented influenced patient treatment
decisions.
Jane Graydon, a University of Toronto nursing professor, found
in her study that ``women want very specific information, and
healthcare professionals must be prepared to provide it throughout
treatment.'' She studied 33 patients, mean age 57 years, undergoing
radiotherapy after breast conservation surgery.
Patients interviewed at the start, middle, end of, and one month
after radiation, had high information requirements. ``At all four
times, their most important needs were related to the disease
itself, how it acts in the body, the chance of recurrence,
treatment, coping with side-effects and impact on life in the next
few weeks,'' said Graydon.
As for decision-making, helping patients make informed choices
about mastectomy or lumpectomy can be made easier when options are
clearly laid out, according to research by Dr. Timothy Whelan of
McMaster University in Hamilton, Ontario, a radiation oncologist,
who used a poster, called a Decision Board, to clarify risks,
benefits and impact on quality of life.
``Since survival rates are about equal with mastectomy and
lumpectomy plus radiation, the decision must be based on
quality-of-life issues and how women feel about their body and
sexuality,'' said Whelan.
In the study were 175 patients, with early-stage cancer, mean
age 56, who were consulting seven surgeons at different Ontario
sites. Following use of the Decision Board, Whelan found the rate
of those choosing lumpectomy/radiation fell compared to mastectomy,
to 73 percent from 88 percent.
Some 96 percent of patients said the poster was easy to
understand, 98 percent felt it offered a clear choice and 81
percent said it facilitated their decision, with 57 percent stating
their treatment preference during the Board session. Patients
averaged a score of 84 percent on a true/false comprehension quiz,
and surgeons rated the Board helpful in communicating risks and
benefits in 91 percent of consultations.
Moving from patient to physician education, University of
Western Ontario, London researcher Moira Stewart, a specialist in
the study of patient-centered care, gave high marks to doctors who
participated in an intensive educational program to improve
communication with breast cancer patients.
Presenting preliminary data, Stewart outlined one part of a
randomized trial that assigned nine family doctors to a two-hour
discussion group and eight to an intensive, six-hour group training
program. The latter involved viewing patient-perspective
videotapes, listening to breast cancer survivors, communicating
with actors playing different patient roles, and getting expert
feedback.
Participants were monitored before and after the training
through audio tapes of their consultations with four role-playing,
``standardized'' patients. Performance was assessed with the
Patient-Centered Scoring Tool, revised to reflect the real-life
experiences and needs of breast cancer patients. The audio tapes
were evaluated ``to see if physicians elicited and validated
patients' feelings and their ideas, and provided support and
hope,'' she explained.
Communication style was also reviewed for clarity of
information, two-way discussion, validation of patients' feelings,
patients' need to feel in control and whether their expectations of
care were met. Another measure was physicians' ability to treat
patients as whole persons, addressing concerns about family,
sexuality and work.
In validating patient feelings, mean scores rose from 75 percent
to 95 percent for the intervention group and fell in the
traditional group from 70 percent to 45 percent. On whole-person
issues, scores rose from 72 percent to 83 percent in the intensive
group but stayed at about 59 percent for controls.
The increases show ``that physicians were now looking at the
patient as a whole person, whereas beforehand, there had been much
more discussion about the disease,'' said Stewart, adding that
future analyses should look at the impact of improved communication
on patient outcomes.
