Patient-provider communication about chemotherapy-induced side effects and management strategies in medical oncology visits

Background: Chemotherapy-induced side effects (CISE) can result in significant morbidity and adversely affect patients' quality of life. Despite advances in the management strategies for CISE, it remains unclear how patients are informed about these strategies, particularly for delayed symptoms (i.e., symptoms that occur hours or days after chemotherapy is administered). Methods: Initial (prior to chemotherapy) and second (after first chemotherapy was administered) visits by patients to an oncologist across 5 sites were audio-recorded. Two researchers coded the recordings. Inter-rater reliability ranged from kappa=.66-.91. Results: Of 38 visits recorded with 22 patients, 24 visits were initial and 14 second. Visits averaged 15.1 minutes (range: 1.8-41.5), with an average of 4.9 minutes (35.5% of visit) spent discussing CISE (range: 0.13-15.8 minutes). Oncologists averaged 4.1 minutes (25.1% of visit) talking about side effects in initial visits compared to 6.2 minutes (53.5% of visit) in second visits. On average there were 3.2 discussions about CISE per visit: whereas on average oncologists discussed management strategies for CISE 1.6 times per visit. Management strategies for CISE were provided in 30 visits (19 pre-chemo, 11 post-chemo) and at least one management strategy was provided for all patients who had more than one visit recorded. Conclusions: CISE were discussed in all visits, although management strategies were discussed in fewer visits and discussed less frequently. The length of side-effect discussions was greater during post-chemo visits than pre-chemo visits. Although each patient with two visits was provided management strategies, further research should explore the most effective ways to impart this information to patients.