Patient-Physician Communication During Outpatient Palliative Treatment Visits
Authors: Symone B. Detmar, Martin J. Muller, Liowina D. V. Wever, Jan H. Schornagel, Neil K. Aaronson
Journal: JAMA (2001)

2][3] In both cases, health-related quality of life (HRQL) issues, defined in terms of the patient's physical, emotional, and social functioning, and wellbeing 4,5 may be of central importance in selecting among available treatment options and in monitoring the effects of such treatments over time.An essential condition for optimal palliative cancer treatment is that physicians communicate effectively with their patients to obtain as complete a picture as possible of the patients' physical and psychosocial health status.][8][9][10][11] Results from these studies indicate that a number of elements play a role in the way in which information is exchanged between physicians and their patients.First, the nature of the symptoms themselves can influence patient-physician communi-cation.For example, Funch, 10 investigating the symptom-reporting behavior of colorectal cancer patients, found that 54% of experienced symptoms were spontaneously reported, and that chronic, nonspecific, and mild symptoms were less likely to be discussed than more acute, concrete, and severe symptoms.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 MeasuresPatient 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. ResultsPhysicians 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. ConclusionDespite 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.