Oncologists’ discussions of treatment goals and prognosis during clinic visits with African Americans with advanced cancer.

Abstract

34 Background: The National Academy of Medicine recommends that cancer patients be informed of their prognosis to enable informed treatment decisions, but research shows few patients receive this information. This problem is greater for minorities, who experience poorer quality clinical communication and end-of-life care relative to white patients. This study describes patient-oncologist discussions about treatment goals/prognosis during clinic visits with African American patients. Methods: Data were from a larger study of communication between African Americans and medical oncologists at two cancer hospitals in Detroit, MI. The present study included video recordings/transcripts of clinic visits with patients with Stage III (n=20) or IV (n=6) cancer and their oncologists (n=9). Two investigators read the transcripts independently to determine whether treatment goals and/or prognosis were mentioned; disagreement was resolved through discussion. Discourse analysis was conducted to describe interactional strategies oncologists used to discuss or avoid discussing these topics. Results: Treatment goals were discussed during most visits (n=24; 92.3%); prognosis was discussed less frequently (n=19; 73.1%). Oncologists often used vague language to describe prognosis (e.g. prognosis is a bit worse in your case). Only one visit included a clear survival estimate. Oncologists used clear language when the goal was cure, but when describing other goals, they often used technical terms (e.g., reduce the risk of recurrence); imprecise terms (e.g., keep the cancer in check); and emphasized uncertainty (e.g., these lesions are suspicious). Oncologists missed opportunities to further explain or elicit patient questions or preferences by directing the discussion to the urgency and details of treatment. Conclusions: Oncologists used ambiguous language to discuss treatment goals/prognosis and missed opportunities to discuss patient perspectives or other options, including palliative care. Interventions are needed to improve communication about these important topics, especially among minority patients with advanced cancer.