This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (53)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Topic Collections  • Patient-Physician Relationship/ Care  • Patient-Physician Communication  • End-of-life Care/ Palliative Medicine  • Quality of Life  • Alert me on articles by topic  Social Bookmarking   What's this?

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.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

A Framework for Narrative-Driven Transformative Learning in Medicine
Brendel
Journal of Transformative Education 2009;7:26-43.
ABSTRACT  

Development and Implementation of a Clinician Reporting System for Advanced Stage Cancer: Initial Lessons Learned
DuBenske et al.
J. Am. Med. Inform. Assoc. 2008;15:679-686.
ABSTRACT | FULL TEXT  

Provider Insights About Palliative Care Barriers and Facilitators: Results of a Rapid Ethnographic Assessment
Goepp et al.
AM J HOSP PALLIAT CARE 2008;25:309-314.
ABSTRACT  

Death-Talks: Transformative Learning for Physicians
Moon
AM J HOSP PALLIAT CARE 2008;25:271-277.
ABSTRACT  

Breast cancer patients' expectations in respect of the physician-patient relationship and treatment management results of a survey of 617 patients
Oskay-Ozcelik et al.
Ann Oncol 2007;18:479-484.
ABSTRACT | FULL TEXT  

High context illness and dying in a low context medical world
Hallenbeck
AM J HOSP PALLIAT CARE 2006;23:113-118.
ABSTRACT  

Empowering the Cancer Patient or Controlling the Tumor? A Qualitative Study of How Cancer Patients Experience Consultations With Complementary and Alternative Medicine Practitioners and Physicians, Respectively
Steinsbekk and Launso
Integr Cancer Ther 2005;4:195-200.
ABSTRACT  

Admission to intensive care unit at the end-of-life: is it an informed decision?
Rady and Johnson
Palliat Med 2004;18:705-711.
ABSTRACT  

Assessing Cancer-Related Quality of Life Across a Spectrum of Applications
Gotay
J Natl Cancer Inst Monogr 2004;2004:126-133.
ABSTRACT | FULL TEXT  

Psychosocial care for cancer patients in primary care? Recognition of opportunities for cancer care
Pascoe et al.
Fam Pract 2004;21:437-442.
ABSTRACT | FULL TEXT  

Comparison of health care professionals' self-assessments of standards of care and patients' opinions on the care they received in hospital: observational study
Durieux et al.
Qual Saf Health Care 2004;13:198-202.
ABSTRACT | FULL TEXT  

The Comprehensive Care Team: A Controlled Trial of Outpatient Palliative Medicine Consultation
Rabow et al.
Arch Intern Med 2004;164:83-91.
ABSTRACT | FULL TEXT  

Role of Health-Related Quality of Life in Palliative Chemotherapy Treatment Decisions
Detmar et al.
JCO 2002;20:1056-1062.
ABSTRACT | FULL TEXT