259255 Delivery of colorectal cancer diagnoses to colonoscopy patients by gastroenterologists

Tuesday, October 30, 2012 : 12:50 PM - 1:10 PM

Jessica Schumacher, PhD , Health Services Research, Management, and Policy, University of Florida, Gainesville, FL
Barbara Curbow, PhD , Behavioral Science and Community Health, University of Florida, Gainesville, FL
Evelyn King-Marshall, MPH , Department of Behavioral Science Community Health, University of Florida, Gainesville, FL
Tracey E. Barnett, PhD , Department of Behavioral Science and Community Health, University of Florida, Gainesville, FL
Amy Dailey, PhD, MPH , Health Sciences Department, Gettysburg College, Gettysburg, PA
Thomas George Jr., MD , Department of Medicine, University of Florida, Gainesville, FL
Emmett Martin, MPH, BA , Department of Behavioral Science Community Health, Unversity of Florida, Gainesville, FL
Elisa Rodriguez, PhD, MS , Behavioral Science and Community Health, University of Florida, College of Public Health and Health Professions, Gainesville, FL
Shanaz Sultan, MD , Department of Medicine, University of Florida, Gainesville, FL
Background: Physician processes for delivering diagnostic news are poorly understood, despite the fact they have critical implications for patient follow-up and treatment. The current study assesses how gastroenterologists (GIs) deliver cancer diagnoses following colonoscopy and how patients perceive diagnosis reporting.

Methods: 30 GIs (mean age 45, 20% female) in university (hospital/clinic), VA, and suburban and rural settings participated in individual semi-structured interviews. GIs were asked to describe the content and setting of patient interactions following colonoscopy when cancer is suspected and/or confirmed and how they convey disease seriousness verbally and non-verbally. Interviews were transcribed and analysis followed an inductive process, allowing for identification of concepts and their interrelatedness. Colonoscopy patients at these clinics were recruited to participate in a colorectal cancer decision-making study. Patient data collection efforts, which include at-colonoscopy surveys and post-diagnosis interviews, are ongoing.

Results: Preliminary analysis suggests most GIs deliver a cancer diagnosis to patients in two steps: 1) disclosing suspected cancer in the recovery room post-colonoscopy and 2) confirming cancer following pathology. During step 1, most providers conveyed verbal seriousness of a suspected diagnosis by indicating they have “bad/unfortunate news,” using the word “cancer” or “malignancy”, describing the need for follow-up treatments/tests, and making referrals/appointments for surgery and/or oncology on the day of colonoscopy. 40% of GIs were unaware of their use of non-verbal cues to convey disease seriousness. Those who did described changing facial expression and voice tone. Other strategies included moving to a quiet environment, making sure a caregiver is present, sitting down, maintaining eye contact, talking with hands, pausing, and touch (e.g., hold hand). During step 2, providers report confirming the diagnosis by phone if cancer was initially suspected or by phone/in-person if not suspected. Providers indicated that telling patients they suspected cancer at colonoscopy was important preparation for the conversation confirming the diagnosis following pathology. These interactions were less difficult than conversations with patients with cancer not suspected at colonoscopy.

Conclusion: Communication of suspected cancer by GIs at colonoscopy plays an important role in preparing patients for a cancer diagnosis and most importantly, lays the foundation for future treatment decision making. These findings underscore the importance of interactions following a procedure complicated by sedation. These reports will be compared to patient reporting of their cancer diagnosis to assess discrepancies. Implications for research and practice are discussed.

Learning Areas:
Communication and informatics
Other professions or practice related to public health
Public health or related research
Social and behavioral sciences

Learning Objectives:
1) Describe gastroenterologists' perceptions of how they deliver a cancer diagnosis to their patients. 2) Demonstrate how these perceptions differ from cancer patients' reporting of their diagnosis experiences.

Keywords: Cancer, Providers

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been an investigator on a number of grants examining patient and provider perceptions of cancer survivorship care. My research and policy interests center around the cancer patient transition from active treatment to longer-term survivorship and how providers and health systems can adopt care strategies to optimize patient outcomes.
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: 4231.0: Social Sciences in Health