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Cancer Patients’ Perception of the Quality of Communication Before and After the Implementation of a Communication Strategy in a Regional Cancer Center in India

From the Palliative Care Unit; Department of Anesthesiology and Gynecologic Oncology, A.H. Regional Cancer Centre, Cuttack, India; and the Department of Palliative Care and Rehabilitation Medicine, M.D. Anderson Cancer Center, Houston, TX

Address reprint requests to Eduardo Bruera, MD, Department of Palliative Care and Rehabilitation Medicine, The University of Texas M.D. Anderson Cancer Center (Unit 8), 1515 Holcombe Blvd, Houston, TX 77030, e-mail: ebruera{at}mdanderson.org

PURPOSE: Physician communication is one of the areas that cancer patients have expressed their lowest level of satisfaction. Very few studies have used patient-based outcomes in the Developing world.

METHODS: We conducted a survey of 400 consecutive patients attending our outpatient clinic (Step I). Survey results were used to make changes in the physical layout of the setting to increase privacy and to educate staff regarding practical techniques on communication (Step II). A second group of 400 patients were interviewed immediately after the implementation of the new communication strategy (Step III).

RESULTS: Comparing Step I (n = 400) and Step III (n = 400) we observed a favorable response ("yes" v "no") with regard to overall satisfaction with communication in 52 patients (13%) versus 132 patients (33%; P = .0001), privacy in 21 patients (5%) versus 279 patients (70%; P = < .001), no interruptions in 170 patients (42%) versus 330 patients (82%; P = < .001), clear language in 57 patients (14%) versus 227 patients (57%; P = < .001), sufficient time in 88 patients (22%) versus 168 patients (42%; P = < .001), doubts cleared by the doctor in 105 patients (26%) versus 225 patients (56%; P = < .001). Patients older than 65 years and manual laborers were significantly more satisfied compared with younger patients and those patients with nonmanual occupations, during both Steps I and III.

CONCLUSION: We conclude that cancer patients in Developing countries have many unmet needs regarding communication and that simple changes in the organization of clinics and oncologist education can result in major improvements in satisfaction with the quality of communication.

Supported in part by an International Union Against Cancer (UICC) International Cancer Technology Transfer Fellowship.

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

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