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Discussing Adjuvant Cancer Therapy

From the Medical Psychology Unit and Department of Cancer Medicine, Royal Prince Alfred Hospital, University of Sydney, Camperdown, New South Wales, Australia.

Address reprint requests to Natasha Leighl, MD, FRCPC, Medical Psychology Unit, Blackburn Building D06, University of Sydney, Camperdown, NSW, 2006, Australia.

PURPOSE: To document the adequacy of patient information in oncology consultations concerning adjuvant therapy and explore predictors of physician communication patterns, treatment decisions, patient information recall, and satisfaction.

PATIENTS AND METHODS: Retrospective analysis of audiotapes and verbatim transcripts of 101 initial adjuvant therapy consultations with medical and radiation oncologists was undertaken. Content analysis, data on communication patterns, treatment decisions, patient anxiety, satisfaction, and information recall were collected. Predictors of physician communication, treatment decisions, recall, and satisfaction with the consultation were identified.

RESULTS: The majority of patients were well informed of their prognosis, benefits and risks of therapy, and alternative management options. Only half were asked about preferences for information or decision-making involvement. Predictors of information detail given include patient sex, age, occupation, and education. Radiation and medical oncologists express prognosis and treatment benefit using similar phrases. When offered the chance to delay decision-making, most patients do so (P < .01). Final treatment decisions appear to be influenced by the presentation of choice in treatment options by the oncologist and whether the treatment decision was made during the initial consultation (P < .01). Information recall was not influenced by communication factors. Patients receiving less detailed information had slightly higher satisfaction with the consultation (P = .03). More anxious patients tended to be less satisfied (P = .07).

CONCLUSION: The optimal way to discuss adjuvant therapy is undefined. More emphasis can be placed on soliciting patient preferences for information and decision-making involvement and tailoring both to the needs of the individual patient. Providing choice in treatment and delaying decision-making may affect the patient’s treatment decision.

Presented at the 36^th Annual Meeting of the American Society of Clinical Oncology, New Orleans, LA, May, 2000.

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