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Patient-Physician Communication During Outpatient Palliative Treatment Visits
An Observational Study
Symone B. Detmar, MSc;
Martin J. Muller, MSc;
Liowina D. V. Wever;
Jan H. Schornagel, MD, PhD;
Neil K. Aaronson, PhD
JAMA. 2001;285:1351-1357.
Context Improving health-related quality of life (HRQL) is an important goal of palliative treatment, but little is known about actual patient-physician communication regarding HRQL topics during palliative treatment.
Objectives To investigate the content of routine communication regarding 4 specific HRQL issues between oncologists and their patients and to identify patient-, physician-, and visit-specific factors significantly associated with discussion of such issues.
Design Observational study conducted between June 1996 and January 1998.
Setting Outpatient palliative chemotherapy clinic of a cancer hospital in the Netherlands.
Participants Ten oncologists and 240 of their patients (72% female; mean age, 55 years) who had incurable cancer and were receiving outpatient palliative chemotherapy.
Main Outcome Measures Patient and physician questionnaires and audiotape analysis of communication regarding daily activities, emotional functioning, pain, and fatigue during an outpatient consultation using the Roter Interaction Analysis System.
Results Physicians devoted 64% of their conversation to medical/technical issues and 23% to HRQL issues. Patients' communication behavior was divided more equally between medical/technical issues (41%) and HRQL topics (48%). Of the independent variables investigated, patients' self-reported HRQL was the most powerful predictor of discussing HRQL issues. Nevertheless, in 20% to 54% of the consultations in which patients were experiencing serious HRQL problems, no time was devoted to discussion of those problems. In particular, these patients' emotional functioning and fatigue were unaddressed 54% and 48% of the time, respectively. Discussion of HRQL issues was not more frequent in consultations in which tumor response was evaluated.
Conclusion Despite increasing recognition of the importance of maintaining patients' HRQL as a goal of palliative treatment, the amount of patient-physician communication devoted to such issues remains limited and appears to make only a modest contribution, at least in an explicit sense, to the evaluation of treatment efficacy in daily clinical practice.
Author Affiliations: Division of Psychosocial Research and Epidemiology (Messrs Detmar, Muller, Wever, and Dr Aaronson) and Department of Medical Oncology (Dr Schornagel), The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
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