Why Do Cancer Patients Have Difficulties Evaluating the Need for a Second Opinion and What Is Needed to Lower the Barrier? A Qualitative Study

Abstract

Background: Requesting a second opinion (SO) is common in oncology. The reasons and barriers for patients not seeking an SO have yet been to be investigated. Why do patients have difficulties evaluating their need for an SO and what could be done to minimize these barriers? Patients and Methods: A 2-stage qualitative study was conducted. 1) Participants were studied in 3 focus groups (FGs). The participants themselves analyzed and then grouped their statements into defined categories. 2) Results of the FGs were discussed with 7 experts from different professional backgrounds. The interviews were unstructured and detailed in the protocol. The statements underwent thematic analysis. Results: The following 4 main barriers were identified: 1) state of shock, 2) pressure of time, 3) sense of excessive demands and uncertainty triggered by information overload, 4) fear of jeopardizing the patient-physician relationship. The following 4 main suggestions for minimizing the barriers were identified: 1) written patient information, 2) improvement of communication, 3) patient empowerment (PE), 4) holistic approach. Conclusion: These barriers incapacitate the patients from evaluating the need for an SO. To minimize the barriers, PE, self-management support and shared decision making is recommended. While the implementation of these concepts advances, patients can be empowered by psycho-oncological assistance.