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Strategic Physician Communication and Oncology Clinical Trials

From the Medical Interaction Research Group, H. Lee Moffitt Cancer Center and Research Institute, Department of Community and Family Health, College of Public Health, Department of Internal Medicine, College of Medicine, and Department of Psychology, College of Arts and Sciences, University of South Florida, Tampa, FL; and Division of Hematology/Oncology, Department of Medicine, Albany Medical College, Albany, NY.

Address reprint requests to Terrance Albrecht, PhD, Department of Community and Family Health, MDC-56, University of South Florida, Tampa, FL 33612; email talbrech{at}com1.med.usf.edu

PURPOSE: Clinical trials are the primary means for determining new, effective treatments for cancer patients, yet the number of patients that accrue is relatively limited. The purpose of this study was to explore the relationship between physician behavior and patient accrual to a clinical trial by videotaping the interaction.

PATIENTS AND METHODS: Forty-eight patient-physician interactions involving 12 different oncologists were videotaped in several clinics at the H. Lee Moffitt Cancer Center and Research Institute (Tampa, FL). The purpose of each interaction was to present the possibility of a clinical trial to the patient. A coding system, the Moffitt Accrual Analysis System, was developed by the authors to code behaviors that represented both the legal-informational and social influence models of communication behavior. Thirty-two patients agreed to participate in the clinical trial.

RESULTS: Videotaping was found to be a viable, valid, and reliable method for studying the interaction. Physicians who were observed to use both models of influence were found to enroll more patients. Thus, patients were more likely to accrue to the trial when their physician verbally presented items normally included in an informed consent document and when they behaved in a reflective, patient-centered, supportive, and responsive manner. Discussion of benefits, side effects, patient concerns and resources to manage the concerns were all associated with accrual.

CONCLUSION: This research has implications for modifying physician behavior and, thus, increasing the numbers of patients accruing to oncology clinical trials.

A previous version of this paper was presented at the annual meeting of the International Communication Association, Montreal, Canada, May 1997. Portions of the data were also presented at a poster session at the Thirteenth Annual Meeting of the Association of Oncology Social Work, Pittsburgh, PA, May, 1997.

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