Prospective Randomized Control Trial Investigating the Impact of a Physician Communicated Radiation Therapy Plan Review on Breast Cancer Patient-Reported Satisfaction

Abstract

Physician communication is a crucial determinant of patient satisfaction that has been understudied for breast radiation therapy (RT). Breast cancer patients face complex medical decision-making about increasingly sophisticated treatments. We investigated the impact of a physician-communicated patient-specific RT plan review on patient reported satisfaction for breast cancer patients receiving adjuvant RT in a prospective randomized trial. We hypothesized that individual RT treatment plan review would positively impact patient satisfaction in areas of communication, competence, confidence, and trust. Patients diagnosed with stage I-III invasive breast cancer who consented to whole-breast or chest-wall RT were prospectively randomized to a standard non-detailed review (Arm A) versus an in depth, individualized RT plan review during week one of RT (Arm B), including visual review of axial, sagittal, and coronal computed tomography slices with isodose lines, beam arrangements, and review of normal tissue doses and tolerance. Patient-reported satisfaction was assessed using a 12 question subset of the FACIT-TS-PS: Functional Assessment of Chronic Illness Therapy - Treatment Satisfaction - Patient Satisfaction questionnaire related to doctor communication (DC), technical competency (TC), and overall treatment satisfaction (OS). The difference in mean scores baseline (Time 1), week one of RT (Time 2), and the final day of RT (Time 3) were examined. Descriptive statistics, paired t-test or Wilcoxon signed-rank test as appropriate, and two-sample t-test were used to describe the results. From March 2014-March 2016, 67 breast cancer patients (36 Arm A, 31 Arm B) were randomized and completed all 3 timepoint surveys. The mean age was 56 years (range 34-81). Stage ranged from pT1bN0 to T4bN1. The scale of the baseline scores for the DC, TC, and OS mean were 2.720 (SD = 0.719), 2.646 (SD = 0.871), and 2.263 (SD = 0.890), respectively. There was no difference in the baseline reported communication indictors between Arm A and B (P = 0.678). There were no statistically significant differences between the 3 timepoints for the DC, TC, or OS (P = 0.581, 0.490, and 0.682, respectively). We report the first randomized trial evaluating the impact of in-depth RT plan review on patient reported satisfaction. Both baseline and post-intervention scores were high for all domains for patients in both arm, and patients were satisfied with their understanding of RT after the in-depth plan review. Patient-reported outcomes are essential to further understand the effect of physician communication on patient reported satisfaction with RT.