Impact of Doctor-Patient Communication on Outcomes in Cancer Survivors
A new study from the American Cancer Society has found that patients with cancer who reported greater satisfaction in the way their provider communicated with them received more efficient care, with fewer office visits and better health outcomes. These findings were published by Rai et al in JNCCN—Journal of the National Comprehensive Cancer Network.
“Our study suggests that when cancer care providers are more effective communicators, their patients are more likely to follow medical advice and medication protocols,” said lead author, Ashish Rai, PhD, Director of Outcomes Research in the Surveillance and Health Services Research Program, American Cancer Society. “Cancer survivors are distinct from many other patients, in terms of their provider communication-related needs and expectations. They are more likely to be older and have additional health concerns. Being diagnosed with cancer and hearing complex information about treatment, costs, and prognosis can cause anxiety. On top of that, there is the fear of possible recurrence. All these factors and more can make cancer survivors particularly sensitive in their perception of good care or communication.”
Study Methods
The researchers used data from the Medical Expenditure Panel Survey (MEPS) from 2008 through 2014 to track outcomes for 4,588 cancer survivors; 2,257 were between 18 and 64 (median age = 54), and the other 2,331 were 65 or older (median age = 75). Communication satisfaction was measured by the Consumer Assessment of Healthcare Providers and Systems in conjunction with the MEPS data.
Patients used a 4-point scale ranging from “never” to “always” to track whether their providers listened carefully, explained things in a way that was easy to understand, showed respect for what the respondent had to say, and spent enough time with the respondent. A global 0-to-10 satisfaction rating scale was also factored into a composite score and tracked across 12 months. The researchers then measured outcomes based on the number of emergency department visits, office visits, and total health-care spending (including medication and out-of-pocket costs).
Results
In both age groups, patients with better baseline health reported higher satisfaction levels, suggesting that more complex circumstances negatively impacted patients’ perception of their communication. The more comorbidities a patient had, the lower their satisfaction rating, highlighting the importance of coordinating care across a team of providers.
“The results of this study present an interesting challenge: those survivors most in need of good communication about complex medical issues may not be receiving the information they seek in a manner that they find helpful. That, in turn, results in higher health-care utilization and expenditure,” commented Crystal Denlinger, MD, FACP, Chief of Gastrointestinal Medical Oncology at Fox Chase Cancer Center and Chair of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Panel on Survivorship. “This could be due to many factors, including time constraints, competing priorities, and increasingly complex cancer therapies. This study highlights the need for additional research into how to tailor the health-care experience both during and after cancer treatment in order to communicate more effectively.”
“Communication needs vary from patient to patient,” said Dr. Rai. “While time constraints do pose a challenge, the amount of time spent is only one of the attributes of effective communication. By tailoring their communication strategy to a patient’s specific needs, providers may be able to communicate more effectively in the same amount of time.”
Dr. Rai also pointed out the importance of delegating both clinical and communication duties to colleagues as needed. As another time-saving measure, the study also cites earlier research demonstrating better outcomes for patients who had the option of communicating with their provider electronically. Ultimately, the researchers concluded that effective provider communication can improve outcomes by streamlining care, alleviating anxiety, boosting mutual trust, and increasing treatment adherence.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
