Improving new cancer diagnosis education in a metropolitan cancer center.
Authors: Sridhar Arthi , Yang Wei , Khan Hina , Maithel Neha , Chan Kok Hoe , Jayan Athira , Dash Akshar , Yusuf Chang 
Published: September 2022

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Background: Oncologists are faced with sharing complex information to their patients when making new cancer diagnoses. Patients often find themselves overwhelmed with the amount of information given to them at this initial visit. This challenging and emotionally charged context often result in patient dissatisfaction. Currently, most patient education is done verbally despite studies showing that patients only retain 14% of verbal communication, compared to 85% when using visual aids (VA).. Gunn et al. showed that cancer patients may be vulnerable to poorer outcomes during treatment if they lack the necessary skills such as health literacy to meet the high informational demands and manage psychosocial stressors. Garcia-Retamero et al showed that the use of VA enables patients across all literacy levels to arrive at better diagnostic inferences; however, the quality and quantity of VA used is not uniform nationwide and little data exists on their use in cancer diagnosis education. Our initiative aims to improve the patient education process at our cancer center. Methods: We developed VA for breast, colon, gastric, and lung cancer clinics. New patients were divided into two, a control arm (CA) which received the current standard education and an intervention arm (IA), which also received VA. Patient surveys based on physician consensus were used to collect patient outcomes. The primary outcomes included patients’ understanding of their diagnosis, the stage of their cancer, and the goal of treatment (cure versus life prolongation). Secondary outcomes included duration of clinic visit and retention of information assessed in a follow up phone call. Results: Sixteen (16) patients participated in the study with 8 in the CA and 8 in the IA group, including 11 females and 5 males. There were 8 Caucasian, 4 African American, 2 Asian and 2 Hispanic patients. Five patients (63%) had breast cancer and 3 (38%) had lung cancer in each arm. CA had 5 patients (63%) with Stage IV disease and IA had 4 patients (50%) with Stage IV disease. IA had better understanding of the goal of treatment (100% IA vs 75% CA, p = 0.13); on follow up, IA were able to better recall the stage of their cancer (88% IA vs 63% CA, p = 0.17) and treatment goal (88% IA vs 50% CA, p = 0.08). IA arm expressed better ability to understand what was communicated to them during the visit (mean score: CA = 4.83, IA = 3.67, p = 0.01). All patients who received the pictorial educational material felt that it helped them better understand the medical information. The total visit time in minutes was 58.67 in in the CA and 44.50 in the IA (p = 0.16). Conclusions: Despite being a small study, we demonstrated a trend towards improved understanding of cancer stage and treatment goal in patients with the use of VA vs standard verbal education. In patients with newly diagnosed breast and lung cancer, the intervention also resulted in lower total visit time. This proof of concept should be reproduced in a larger study.