228183 Linking patient-physician communication with receipt of guideline concordant cancer care: What are the patient perspectives?

Sunday, November 7, 2010

Heather A.K. Elliott, BA , Dept. of Health Management and Policy, University of Michigan, Ann Arbor, MI
Elizabeth A. Becker, MPH , Dept. of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI
Gwen L. Alexander, PhD, MPH , Cancer Epidemiology, Prevention and Control, Henry Ford Health System, Detroit, MI
Jennifer J. Griggs, MD, MPH , Department of Internal Medicine, University of Michigan, Ann Arbor, MI
Arden M. Morris, MD, MPH , Department of Health Behavior and Health Education, Department of Surgery, University of Michigan, Ann Arbor, MI
Background: This purpose of this mixed-methods study was to clarify the influence of the patient-physician relationship (as described by patients) on adherence to recommended colorectal cancer chemotherapy.

Methods: After securing IRB approval, we invited colorectal cancer patients from a tertiary center to participate. Inclusion criteria were (1) Surgical excision <=6 months prior, (2) Stage II-III colorectal cancer, (3) Previous discussion of chemotherapy per the patient, (4) English-speaking and able to hear. Clinical data were abstracted from patient charts. In person or telephone semi-structured interviews were conducted by trained interviewers using a guide. Data were analyzed iteratively using grounded theory techniques. Codes were developed and revised into a coding manual subsequently applied to all interviews. Themes were identified, refined to saturation, and validated via triangulation.

Results: 28 colorectal cancer patients agreed to be interviewed over a 6 month period. Among these, 50% did not receive guideline concordant colorectal cancer care. Patients reported that decisions for chemotherapy care were based on communication and trust in their physicians (surgeons and medical oncologists) and on concordance between physician and patient communication preferences. In general, patients reported that the surgeon influence outweighed the medical oncologist influence on decision making for chemotherapy.

Conclusion: Patient-reported communication with surgeons about their cancer, coupled with patients' underlying communication preferences, had a major influence on decision making for chemotherapy. Combining qualitative methods with clinical records offers a unique perspective into gaps in patient understanding and subsequent adherence to recommended treatment. Important factors for future research include (1) concordance between provider and patient communication preferences and (2) assessing patient communication preferences to maximize effectiveness of the clinical encounter.

Learning Areas:
Communication and informatics
Other professions or practice related to public health
Planning of health education strategies, interventions, and programs
Social and behavioral sciences

Learning Objectives:
Describe the influence of patient-procvider relationships on patients' decision making around colorectal cancer treatment. Explain the influence of the surgeon in patient decision making beyond surgical care.

Keywords: Cancer, Communication

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I am responsible for analysis of study data and study completion.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 2067.0: Medical Care Section Poster Session III: Health Services Research