Patient-clinician communication among patients with stage I lung cancer
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.
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.
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).
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.
KeywordsPatient-clinician communication Lung cancer Stereotactic radiation therapy Psychosocial outcomes
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.
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.
Compliance with ethical standards
Conflict of interest
Authors have disclosed that they do not have any conflicts of interest.
The authors would agree to allow the journal to review the data if requested.
- 1.American Cancer Society (2016) Cancer facts and statistics. Cancer.org. http://www.cancer.org/research/cancerfactsstatistics/index. Accessed 22 Feb 2017
- 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.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
- 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
- 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
- 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.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
- 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.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
- 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
- 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.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.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.O’Connor, AM (1993) User manual—Decisional Conflict Scale. Ottawa Hospital Research Institute. Ottawa, Ontario [updated 2010]Google Scholar
- 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.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
- 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.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
- 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