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Supportive Care in Cancer

, Volume 26, Issue 5, pp 1625–1633 | Cite as

Patient-clinician communication among patients with stage I lung cancer

  • Shannon M. Nugent
  • Sara E. Golden
  • Charles R. ThomasJr
  • Mark E. Deffebach
  • Mithran S. Sukumar
  • Paul H. Schipper
  • Brandon H. Tieu
  • Drew Moghanaki
  • Juan Wisnivesky
  • Christopher Slatore
Original Article

Abstract

Purpose

Limited data exist about patient-centered communication (PCC) and patient-centered outcomes among patients who undergo surgery or stereotactic body radiation therapy (SBRT) for stage I non-small cell lung cancer (NSCLC). We aimed to examine the relationship between PCC and decision-making processes among NSCLC patients, using baseline data from a prospective, multicenter study.

Methods

Patients with stage 1 NSCLC completed a survey prior to treatment initiation. The survey assessed sociodemographic characteristics, treatment decision variables, and patient psychosocial outcomes: health-related quality of life (HRQOL), treatment self-efficacy, decisional conflict, and PCC.

Results

Fifty-two percent (n = 85) of 165 individuals planned to receive SBRT. There were no baseline differences detected on patient psychosocial outcomes between those who planned to receive SBRT or surgery. All participants reported high HRQOL (M = 72.5, SD = 21.3) out of 100, where higher scores indicate better functioning; high self-efficacy (M = 1.5, SD = 0.5) out of 6, where lower numbers indicate higher self-efficacy; minimal decisional conflict (M = 15.2, SD = 12.7) out of 100, where higher scores indicate higher decisional conflict; and high levels of patient-centered communication (M = 2.4, SD = 0.8) out of 7 where higher scores indicate worse communication. Linear regression analyses adjusting for sociodemographic and clinical variables showed that higher quality PCC was associated with higher self-efficacy (β = 0.17, p = 0.03) and lower decisional conflict (β = 0.42, p < 0.001).

Conclusions

Higher quality PCC was associated with higher self-efficacy and lower decisional conflict. Self-efficacy and decisional conflict may influence subsequent health outcomes. Therefore, our findings may inform future research and clinical programs that focus on communication strategies to improve these outcomes.

Keywords

Patient-clinician communication Lung cancer Stereotactic radiation therapy Psychosocial outcomes 

Notes

Acknowledgements

The authors thank the following: VA Portland Health Care System: Mark E. Deffebach, M.D., Mithran S. Sukumar, M.D., and Sujata Thakutra, M.P.A.:H.A.; Oregon Health & Science University: Paul H. Schipper, M.D., Brandon H. Tieu, M.D., Charles R. Thomas Jr., M.D., Charlotte Kubicky, M.D., Ph.D., and John Holland, M.D.; Legacy Health System: Andrew Y. Kee, M.D., and Andrew C. Tsen, M.D.; Providence Health & Services: John R. Handy Jr., M.D., Hon.D., and Steven Seung, MD, Ph.D., FACR; PeaceHealth Southwest Washington Medical Center: Michael A. Myers, M.D., and Dennis L. Febinger, M.D.; Tuality Healthcare: Timur Mitin, M.D., Ph.D., and Srinivas R. Mummadi, M.D., FCCP; and Kaiser Permanente: Kelli D. Salter, M.D., Ph.D., David G. Tse, M.D., and Thomas D. Wynne, M.D.

Author contributions

All authors have made substantial contributions to the conception and design, acquisition of data, or analysis and interpretation of data; have contributed to drafting the article for important intellectual content; and have provided final approval of the version to be published.

Funding

This study is supported by an award from the Radiation Oncology Institute (no. ROI2013-915, Radiation Therapy & Patient-Centered Outcomes among Lung Cancer Patients). It was also supported by resources from the VA Portland Health Care System, Portland, Oregon and the Hunter Holmes McGuire Veteran Affairs Medical Center, Richmond, Virginia. Dr. Slatore was supported by a VA HSR&D Career Development Award (CDA 09-025) while the current study was ongoing. Dr. Moghanaki is supported by the VA Cooperative Studies Program (CSP no. 2005).

The Department of Veterans Affairs did not have a role in the conduct of the study; in the collection, management, analysis, or interpretation of data; or in the preparation of the manuscript. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the US Government.

Compliance with ethical standards

Conflict of interest

Authors have disclosed that they do not have any conflicts of interest.

Data sharing

The authors would agree to allow the journal to review the data if requested.

Supplementary material

520_2017_3992_MOESM1_ESM.docx (722 kb)
ESM 1 (DOCX 722 kb)

References

  1. 1.
    American Cancer Society (2016) Cancer facts and statistics. Cancer.org. http://www.cancer.org/research/cancerfactsstatistics/index. Accessed 22 Feb 2017
  2. 2.
    U.S. Preventative Services Task Force (2013) Lung cancer: screening. Uspreventitiveservicetaskforce.org. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/lung-cancer-screening. Accessed 22 Feb 2017
  3. 3.
    Humphrey L, Deffebach M, Pappas M, et al (2013) U.S. screening for lung cancer: systematic review to update the U.S. Preventive Services Task Force Recommendation. Agency for Healthcare Research and Quality (US). Evidence Synthesis no. 105. AHRQ publication no. 13-05196-EF-1. Rockville, MarylandGoogle Scholar
  4. 4.
    Detterbeck FC, Mazzone PJ, Naidich DP, Bach PB (2013) Screening for lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 143(5_suppl):e78S–e92SCrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Colice GL, Shafazand S, Griffin JP, Keenan R, Bolliger CT (2007) Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: ACCP evidenced-based clinical practice guidelines (2nd edition). Chest 132(3):161S–177S.  https://doi.org/10.1378/chest.07-1359 CrossRefPubMedGoogle Scholar
  6. 6.
    Chang JY, Roth JA (2007) Stereotactic body radiation therapy for stage I non-small cell lung cancer. Thorac Surg Clin 17(2):251–259.  https://doi.org/10.1016/j.thorsurg.2007.03.011 CrossRefPubMedGoogle Scholar
  7. 7.
    Haasbeek CJ, Lagerwaard FJ, Antonisse ME, Slotman BJ, Senan S (2010) Stage I nonsmall cell lung cancer in patients aged > or =75 years: outcomes after stereotactic radiotherapy. Cancer 116(2):406–414.  https://doi.org/10.1002/cncr.24759 CrossRefPubMedGoogle Scholar
  8. 8.
    Haque W, Szeja S, Tann A, Kalra S, Teh BS (2016) Changes in treatment patterns and overall survival in patients with early-stage non-small cell lung cancer in the United States after the incorporation of stereotactic ablative radiation therapy. J Clin Oncol 00(00):1–8Google Scholar
  9. 9.
    Nyman J, Johansson KA, Hulten U (2006) Stereotactic hypofractionated radiotherapy for stage I non-small cell lung cancer—mature results for medically inoperable patients. Lung Cancer 51(1):97–103.  https://doi.org/10.1016/j.lungcan.2005.08.011 CrossRefPubMedGoogle Scholar
  10. 10.
    Timmerman R, Paulus R, Galvin J, Michalski J, Straube W, Bradley J, Fakiris A, Bezjak A, Videtic G, Johnstone D, Fowler J, Gore E, Choy H (2010) Stereotactic body radiation therapy for inoperable early stage lung cancer. JAMA 303(11):1070–1076.  https://doi.org/10.1001/jama.2010.261 CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Palma D, Visser O, Lagerwaard FJ, Belderbos J, Slotman BJ, Senan S (2010) Impact of introducing stereotactic lung radiotherapy for elderly patients with stage I non-small-cell lung cancer: a population-based time-trend analysis. J Clin Oncol 28(35):5153–5159.  https://doi.org/10.1200/JCO.2010.30.0731 CrossRefPubMedGoogle Scholar
  12. 12.
    Pan H, Rose BS, Simpson DR, Mell LK, Mundt AJ, Lawson JD (2013) Clinical practice patterns of lung stereotactic body radiation therapy in the United States: a secondary analysis. Am J Clin Oncol 36(3):269–272.  https://doi.org/10.1097/COC.0b013e3182467db3 CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Pan H, Simpson DR, Mell LK, Mundt AJ, Lawson JD (2011) A survey of stereotactic body radiotherapy use in the United States. Cancer 117(19):4566–4572.  https://doi.org/10.1002/cncr.26067 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Tipton K, Launders JH, Inamdar R, Miyamoto C, Schoelles K (2011) Stereotactic body radiation therapy: scope of the literature. Ann Intern Med 154(11):737–745.  https://doi.org/10.7326/0003-4819-154-11-201106070-00343 CrossRefPubMedGoogle Scholar
  15. 15.
    Chang JY, Senan S, Paul MA, Mehran RJ, Louie AV, Balter P, Groen HJM, McRae SE, Widder J, Feng L, van den Borne BEEM, Munsell MF, Hurkmans C, Berry DA, van Werkhoven E, Kresl JJ, Dingemans AM, Dawood O, Haasbeek CJA, Carpenter LS, de Jaeger K, Komaki R, Slotman BJ, Smit EF, Roth JA (2015) Stereotactic ablative radiotherapy versus lobectomy for operable stage I non-small-cell lung cancer: a pooled analysis of two randomized trials. Lancet Oncol 16(6):630–637.  https://doi.org/10.1016/S1470-2045(15)70168-3 CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Louie AV, Werkhoven EV, Chen H et al (2015) Patient reported outcomes following stereotactic ablative radiotherapy or surgery for stage IA non-small-cell lung cancer: results from the ROSEL multicenter randomized trial. Radiother and Oncologia 117(1):44–48CrossRefGoogle Scholar
  17. 17.
    LM W, Austin J, Hamilton JG et al (2012) Self-efficacy beliefs mediate the relationship between subjective cognitive functioning and physical and mental well-being after hematopoietic stem cell transplant. Psycho-Oncologia 21(11):1175–1184CrossRefGoogle Scholar
  18. 18.
    Mosher CE, Lipkus I, Sloane R, Snyder DC, Lobach DF, Demark-Wahnefried W (2013) Long-term outcomes of the FRESH START trial: exploring the role of self-efficacy in cancer survivors’ maintenance of dietary practices and physical activity. Psycho-Oncologia 22(4):876–885CrossRefGoogle Scholar
  19. 19.
    Miller SM, Bowen DJ, Croyle RT, Rowland JH (2009) Handbook of cancer control and behavioral science: a resource for researchers, practitioners, and policy makers, 1st edn. American Psychological Association, Washington, DC.  https://doi.org/10.1037/14499-000 CrossRefGoogle Scholar
  20. 20.
    Kaplan AL, Crespi CM, Saucedo JD, Connor SE, Litwin MS, Saigal CS (2014) Decisional conflict in economically disadvantaged men with newly diagnosed prostate cancer: baseline results from a shared decision-making trial. Cancer 120(17):2721–2727.  https://doi.org/10.1002/cncr.28755 CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Slatore CG, Press N, DH A, Curtis JR, Wiener RS, Ganzini L (2013) What the heck is a “nodule”? A qualitative study of veterans with pulmonary nodules. Ann Am Thorac Soc 10(4):330–335.  https://doi.org/10.1513/AnnalsATS.201304-080OC CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Venetis MK, Robinson JD, Turkiewicz KL, Allen M (2009) An evidence base for patient-centered cancer care: a meta-analysis of studies of observed communication between cancer specialists and their patients. Patient Educ Couns 77(3):379–383.  https://doi.org/10.1016/j.pec.2009.09.015 CrossRefPubMedGoogle Scholar
  23. 23.
    Epstein EM, Duberstein PR, Fenton JJ et al (2017) Effect of a patient-centered communication intervention on oncologist-patient communication, quality of life, and health care utilization in advanced cancer: the VOICE randomized clinical trial. JAMA Oncol 3(1):92–100.  https://doi.org/10.1001/jamaoncol.2016.4373 PubMedPubMedCentralGoogle Scholar
  24. 24.
    Tariq SH, Tumosa N, Chibnall JT, Perry MH 3rd, Morley JE (2006) Comparison of the Saint Louis University mental status examination and the mini-mental state examination for detecting dementia and mild neurocognitive disorder—a pilot study. Am J Geriatr Psychiatry 14(11):900–910.  https://doi.org/10.1097/01.JGP.0000221510.33817.86 CrossRefPubMedGoogle Scholar
  25. 25.
    O’Connor, AM (1993) User manual—Decisional Conflict Scale. Ottawa Hospital Research Institute. Ottawa, Ontario [updated 2010]Google Scholar
  26. 26.
    Wolf MS, Chang CH, Davis T, Makoul G (2005) Development and validation of the Communication and Attitudinal Self-Efficacy scale for cancer (CASE-cancer). Patient Educ Couns 57(3):333–341.  https://doi.org/10.1016/j.pec.2004.09.005 CrossRefPubMedGoogle Scholar
  27. 27.
    Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, Haes JCJM, Kaasa S, Klee M, Osoba D, Razavi D, Rofe PB, Schraub S, Sneeuw K, Sullivan M, Takeda F (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85(5):365–376.  https://doi.org/10.1093/jnci/85.5.365 CrossRefPubMedGoogle Scholar
  28. 28.
    Dinescu FV, Tiple C, Chirila M, Muresan R, Drugan T, Cosgarea M (2016) Evaluation of health-related quality of life with EORTC QLQ-C30 and QLQ-H&N35 in Romanian laryngeal cancer patients. Eur Arch Otorhinolaryngol 273(9):2735–2740.  https://doi.org/10.1007/s00405-015-3809-0 CrossRefPubMedGoogle Scholar
  29. 29.
    Bergman B, Aaronson NK, Ahmedzai S, Kaasa S, Sullivan M (1994) The EORTC QLQ-LC13: a modular supplement to the EORTC Core Quality of Life Questionnaire (QLQ-C30) for use in lung cancer clinical trials. EORTC Study Group on Quality of Life. Eur J Cancer 30a(5):635–642CrossRefPubMedGoogle Scholar
  30. 30.
    Osoba D, Rodrigues G, Myles J, Zee B, Pater J (1998) Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol 16(1):139–144.  https://doi.org/10.1200/JCO.1998.16.1.139 CrossRefPubMedGoogle Scholar
  31. 31.
    Degner LF, Sloan JA, Venkatesh P (1997) The control preferences scale. Can J Nurs Res 29(3):21–43PubMedGoogle Scholar
  32. 32.
    Powell H, McCaffery K, Murphy VE, Hensley MJ, Clifton VL, Giles W, Gibson PG (2011) Psychosocial outcomes are related to asthma control and quality of life in pregnant women with asthma. J Asthma 48(10):1032–1040.  https://doi.org/10.3109/02770903.2011.631239 CrossRefPubMedGoogle Scholar
  33. 33.
    Hudon C, Fortin M, Haggerty JL, Lambert M, Poitras ME (2011) Measuring patients’ perceptions of patient-centered care: a systematic review of tolls for family medicine. Ann Fam Med 9(2):155–164.  https://doi.org/10.1370/afm.1226 CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Little P, Everitt H, Williamson I, Warner G, Moore M, Gould C, Ferrier K, Payne S (2001) Observational study of effect of patient centeredness and positive approach on outcomes of general practice consultations. BMJ 323(7318):908–911.  https://doi.org/10.1136/bmj.323.7318.908 CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Vinokur AD, Threatt BA, Vinokur-Kaplan D, Satariano WA (1990) The process of recovery from breast cancer for younger and older patients. Changes during the first year. Cancer 65(5):1242–1254.  https://doi.org/10.1002/1097-0142(19900301)65:5<1242::AID-CNCR2820650535>3.0.CO;2-1 CrossRefPubMedGoogle Scholar
  36. 36.
    Schwarzer R, Lippke S, Luszczynska A (2011) Mechanisms of health behavior change in persons with chronic illness or disability: the Health Action Process Approach (HAPA). Rehabil Psychol 56(3):161–170.  https://doi.org/10.1037/a0024509 CrossRefPubMedGoogle Scholar
  37. 37.
    Yang LY, Manahs DS, Howard AF, Olson RA. (2017) Patient-reported outcome use in oncology: a systematic review of the impact on patient-clinician communication. Support Care CancerGoogle Scholar

Copyright information

© This is a U.S. government work and its text is not subject to copyright protection in the United States; however, its text may be subject to foreign copyright protection 2017

Authors and Affiliations

  • Shannon M. Nugent
    • 1
    • 2
  • Sara E. Golden
    • 1
  • Charles R. ThomasJr
    • 3
  • Mark E. Deffebach
    • 4
    • 5
  • Mithran S. Sukumar
    • 6
  • Paul H. Schipper
    • 6
  • Brandon H. Tieu
    • 6
  • Drew Moghanaki
    • 7
  • Juan Wisnivesky
    • 8
  • Christopher Slatore
    • 1
    • 3
    • 4
    • 5
  1. 1.Center to Improve Veteran Involvement in CareVA Portland Health Care System (R&D66)PortlandUSA
  2. 2.Division of PsychiatryOregon Health & Science UniversityPortlandUSA
  3. 3.Department of Radiation Medicine, Knight Cancer InstituteOregon Health & Science UniversityPortlandUSA
  4. 4.Division of Pulmonary & Critical Care Medicine, Department of MedicineOregon Health & Science UniversityPortlandUSA
  5. 5.Section of Pulmonary & Critical Care MedicineVA Portland Health Care SystemPortlandUSA
  6. 6.Division of Cardiothoracic Surgery, Department of SurgeryOregon Health & Science UniversityPortlandUSA
  7. 7.Division of Clinical ResearchHunter Holmes McGuire Veterans Affairs Medical CenterRichmondUSA
  8. 8.Division of General Internal MedicineIcahn School of Medicine at Mount SinaiNew York CityUSA

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