ATLANTA -- Making treatment decisions during medical consultations after a cancer diagnosis has become increasingly complex and stressful for patients and physicians, according to a researcher at the University of California San Francisco.
Patients often withhold their questions and concerns during these sessions. In addition, physicians have limited time and resources to synthesize a patient's detailed medical history, personal preferences and relevant medical information. As a result, breast cancer patients often leave medical consultations feeling confused, frustrated and anxious about treatment decisions, says Laura Esserman, MD, MBA, director of the UCSF Carol Franc Buck Breast Care Center, who will present data today at the annual American Society of Clinical Oncology (ASCO) meeting.
However, in a new study, Esserman found that by applying well-established decision making business techniques to medical consultations, breast cancer patients were more satisfied with their treatment decisions.
The study was conducted by researchers at the University of California San Francisco Carol Franc Buck Breast Care Center and Stanford Department of Engineering Economic Systems.
Karen Sepucha, PhD, a graduate student from Stanford University, worked with Esserman and others at the UCSF Breast Care Center to develop a structure for medical consultations. This structure, which utilized techniques such as agenda setting, meeting facilitation and recording, helped to elicit patient preferences, clarify medical details and review options and outcomes.
"Applying these techniques to medical consultations leveraged both patients' and physicians' time and in doing so, made patients' treatment choices and outcomes clearer," Esserman says. "Patients felt reassured that their questions and concerns were being addressed and answered, their stress was reduced, and ability to listen improved."
She notes that the techniques enabled patients and physicians to combine evidence-and preference-based medicine to maximize treatment decision quality. They also enhanced patient-physician communication and collaborative decision-making, elements that have been linked to improved patient outcomes and treatment compliance.
During the pilot study, 24 breast cancer patients facing treatment decisions were divided into a control and intervention group (12 women in each arm). Both patient groups participated in a medical consultation session. In the intervention group, a trained facilitator created and implemented a meeting agenda, and facilitated and recorded the consultation. In the control group, a trained facilitator only observed the consultation.
Using a scale of 1-20 (20 as the highest score), women in the intervention group reported a significantly higher final decision quality compared to those in the control group (median score 14 versus 10); an improvement in overall decision quality (median score 9.7 versus 6.6); and higher satisfaction with their medical consultation (median score 11 versus 7).
Further, patients and physicians in the intervention group achieved a significantly higher level of agreement about decision quality compared to those in the control group.
A patient's decision quality was defined as the level of understanding she has of her diagnosis, treatment options and their risks and benefits, personal preferences and comfort with final decisions.
"As critical decision making has transferred to the outpatient setting and patients desire more participation in the process, better tools to elicit patient preferences and describe treatment options are needed," Esserman says.
"Our next step is to propose a more extensive study where we will test consultation recording and facilitation mechanisms in a larger group of patients and physicians."
The study was funded in part by the U.S. Department of Defense (DOD) and the Arthur Vining Davis Foundation. Other authors of the study include Jeff Belkora, PhD; Karen Sepucha, PhD; and Debasish Tripathy, MD, UCSF associate clinical professor of medicine.