Abstract
BackgroundRealistic pre-treatment expectations are important and have been associated with post-treatment health related quality of life (HRQOL). Patient expectations are greatly influenced by physicians, as they are the primary resource for information. This study aimed to explore the communication practices of physicians regarding treatment outcomes for patients with spinal metastases, and physician experiences with patients’ pre-treatment expectations.MethodsAn international qualitative study using semi-structured interviews with physicians routinely involved in treating metastatic spine disease (spine surgeons, radiation and medical oncologists, and rehabilitation specialists) was conducted. Physicians were interviewed about the content and extent of information they provide to patients with spinal metastases regarding treatment options, risks and treatment outcomes. Interviews were transcribed verbatim and analyzed using a thematic coding network.ResultsAfter 22 interviews data saturation occurred. The majority of the physicians indicated that they currently do not establish patients’ pre-treatment expectations, despite acknowledging the importance of these expectations. Spine surgeons often believe that patient expectations are disproportionate. Physicians expressed they manage expectations by detailing the most common risks and providing a broad but nonspecific overview of treatment outcomes. While the palliative intent seems clear to the physicians, their perception is that the implications of a palliative treatment remains elusive to most patients.ConclusionThis study highlights the current gap in patient-physician communication regarding expectations of treatment outcomes of patients with spinal metastases. These results warrant further research to improve communication practices and determine the effect of patient expectations on patient reported outcomes in this population.
Highlights
Management of patients with symptomatic spinal metastases is challenging and often involves a multidisciplinary approach including medical oncologists, radiation oncologists and spine surgeons
In a recent systematic review on patient expectations regarding treatment outcomes of spinal surgery and advanced cancer care we demonstrated that patients tend to have overly optimistic expectations regarding symptom relief, recovery and prognosis [7]
Between May and October 2019, interviews were conducted with spine surgeons (N = 11), radiation oncologists (N = 6), medical oncologists (N = 3) and rehabilitation specialists (N = 2)
Summary
Management of patients with symptomatic spinal metastases is challenging and often involves a multidisciplinary approach including medical oncologists, radiation oncologists and spine surgeons. The decision for a patient to accept a palliative cancer treatment is influenced by the expected effect of a treatment on their symptom burden and HRQOL [1]. A recent study demonstrated similar satisfaction rates after surgery and radiation therapy for the treatment of spinal metastases, despite significant differences in HRQOL outcomes between the two treatment groups. This may be explained by appropriately counseling patients towards realistic treatment expectations, expectations were not evaluated by the authors [6]. Realistic pre-treatment expectations are important and have been associated with post-treatment health related quality of life (HRQOL). This study aimed to explore the communication practices of physicians regard‐ ing treatment outcomes for patients with spinal metastases, and physician experiences with patients’ pre-treatment expectations
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
