Patient-oncologist Relationship Research Articles

First impressions: A prospective evaluation of patient-physician concordance and satisfaction following the initial medical oncology consultation.

An especially significant event in the patient-oncologist relationship is the initial consultation, where many complex topics-diagnosis, treatment intent, and often, prognosis-are discussed in a relatively short period of time. This study aimed to measure patients' understanding of the information discussed during their first medical oncology visit and their satisfaction with the communication from medical oncologists. Between January and August 2021, patients without prior systemic treatment of their gastrointestinal malignancy (GI) attending the Princess Margaret Cancer Centre (PMCC) were approached within 24 h of their initial consultation to complete a paper-based questionnaire assessing understanding of their disease (diagnosis, treatment plan/intent, and prognosis) and satisfaction with the consultation. Medical oncology physicians simultaneously completed a similar questionnaire about the information discussed at the initial visit. Matched patient-physician responses were compared to assess the degree of concordance. A total of 184 matched patient-physician surveys were completed. The concordance rates for understanding of diagnosis, treatment plan, treatment intent, and prognosis were 92.9%, 59.2%, 66.8%, and 59.8%, respectively. After adjusting for patient and physician variables, patients who reported treatment intent to be unclear at the time of the consultation were independently associated with lower satisfaction scores (global p = 0.014). There was no statistically significant association between patient satisfaction and whether prognosis was disclosed (p = 0.08). An in-depth conversation as to what treatment intent and prognosis means is reasonable during the initial medical oncology consultation to ensure patients and caregivers have a better understanding about their cancer.

Factors and Barriers to Goals-of-Care Conversations for Patients With Cancer and Inpatient Mortality.

Conversations about personal values and goals of care (GOC) at the end of life are essential in caring for patients with advanced cancer. However, GOC conversations may be influenced by patient and oncologist factors during transitions of care. We electronically administered surveys to medical oncologists of inpatients who died from May 1, 2020, to May 31, 2021. Primary outcomes included oncologists' knowledge of inpatient death, anticipation of patient death, and recollection of GOC discussions. Secondary outcomes, including GOC documentation and advance directives (ADs), were collected retrospectively from electronic health records. Outcomes were analyzed for association with patient, oncologist, and patient-oncologist relationship factors. For 75 patients who died, 104/158 (66%) surveys were completed by 40 inpatient and 64 outpatient oncologists. Eighty-one oncologists (77.9%) were aware of patients' deaths, 68 (65.4%) anticipated patients' deaths within 6 months, and 67 (64.4%) recalled having GOC discussions before or during the terminal hospitalization. Outpatient oncologists were more likely to report knowledge of patient death (P < .001), as were those with longer therapeutic relationships (P < .001). Inpatient oncologists were more likely to correctly anticipate patient death (P = .014). Secondary outcomes revealed 21.3% of patients had documented GOC discussions before admission and 33.3% had ADs; patients with a longer duration of cancer diagnosis were more likely to have ADs (P = .003). Oncologist-reported barriers to GOC included unrealistic expectations from patients or family (25%) and decreased patient participation because of clinical conditions (15%). Most oncologists recalled having GOC discussions for patients with inpatient mortality, yet documentation of serious illness conversations remained suboptimal. Further studies are needed to examine barriers to GOC conversations and documentation during transitions of care and across health care settings.

Patient-oncologist working alliance and its relation to locus of control.

In this study, we assessed the patient-oncologist relationship, conceptualized as the working alliance from a dyadic perspective, and its relation to locus of control. One hundred and three oncologist-patient dyads were recruited. Measures included a sociodemographic and medical questionnaire; the "internal, powerful others, and chance" locus of control scale; and the working alliance inventory. Application of the actor-partner interdependence model yielded 2 actor effects: a positive association between oncologist "internal" locus of control and oncologist working alliance, and a negative association between oncologist "chance" locus of control and oncologist working alliance. It also yielded one partner effect: a positive association between oncologist "internal" locus of control and patient working alliance. The actor-partner effect suggests that oncologists' locus of control has a role in the establishment of the patient-oncologist working alliance; oncologists' internal locus of control is a dominant factor affecting not only their own perceived alliance but patients' perceived alliance as well.

Characterizing experiences of non-medical switching to trastuzumab biosimilars using data from internet-based surveys with US-based oncologists and breast cancer patients

PurposeTo characterize current experiences with communication and decision-making practices when non-medical switching to a biosimilar trastuzumab is proposed or required by cancer center or insurer.MethodsWe developed and launched 60- and 51-item internet surveys to elicit US breast cancer patient and medical oncologist lived experiences with trastuzumab biosimilars and patient information needs and seeking practices. We recruited participants using social media and administered via REDCap in 2020–2021.Results143 breast cancer patients and 33 medical oncologists completed the surveys. 63.9% patients reported having switched to a trastuzumab biosimilar and 40.8% reported receiving no prior notification about switching. 44% of patients reported learning about biosimilars primarily through self-directed learning and 41% wanting more time to discuss with oncologist. None of the oncologists reported that the decision to switch a patient to a biosimilar was initiated by them, but rather more frequently by the insurer (45.2%). About 54.8% reported not receiving any pharmaceutical manufacturer material related to the selected biosimilar. Patients and oncologists diverged in their responses to items regarding patient opportunities to ask questions, adequacy of resources, effectiveness of treatment, patient worry, and magnitude of change.ConclusionThere is a need for tailored and effective patient and oncologist information and education on trastuzumab biosimilars, along with improved healthcare communication regarding switching. The discrepancy between patient-reported experiences and oncologist perceptions of the patient experience, suggests a lack of adequate information that may be a challenge not only to the uptake of trastuzumab biosimilars, but to the patient-oncologist relationship.

The Role of Medical Mistrust in Concerns about Tumor Genomic Profiling among Black and African American Cancer Patients.

Tumor genomic profiling (TGP) is used in oncology practice to optimize cancer treatment and improve survival rates. However, TGP is underutilized among Black and African American (AA) patients, creating potential disparities in cancer treatment outcomes. Cost, accuracy, and privacy are barriers to genetic testing, but medical mistrust (MM) may also influence how Black and AA cancer patients perceive TGP. From December 2019 to February 2020, 112 Black and AA adults from two outpatient oncology sites in Philadelphia, PA without a known history of having TGP testing conducted completed a cross-sectional survey. Items queried included sociodemographic characteristics, clinical factors, patient–oncologist relationship quality, medical mistrust, and concerns about TGP. A k-means cluster analysis revealed two distinct psychographic clusters: high (MM-H) versus low (MM-L) medical mistrust. Clusters were not associated with any sociodemographic or clinical factors, except for age (MM-H patients older than MM-L patients, p = 0.006). Eleven TGP concerns were assessed; MM-H patients expressed greater concerns than MM-L patients, including distrust of the government, insurance carriers, and pharmaceutical companies. TGP concerns varied significantly based on level of medical mistrust, irrespective of sociodemographic characteristics. Targeted communications addressing TGP concerns may mitigate disparities in TGP uptake among those with medical mistrust.

Abstract P2-13-13: The patient-centered paradox: A US-based survey of physician- and patient-reported experiences with biosimilar trastuzumab

Abstract Background Biologics, such as trastuzumab (Herceptin) for HER2+ breast cancer, have been revolutionary in improving survival for early stage and metastatic disease. However, their high cost increases cancer care expenses. Recent approval of trastuzumab biosimilars is promising in terms of cost savings and health benefits of access to life-saving treatment for more patients. Although clinical trials have demonstrated equivalence in efficacy and safety between biosimilars and the reference drug, multiple barriers to uptake have been identified. Ours is the first survey comparing the experiences and perspectives of oncologists and patients. Methods We developed a 60-item survey to characterize the experiences of US patients (with HER2+ breast cancer) and oncologists with trastuzumab biosimilar(s). Survey invitations were distributed via social media and data were collected using REDCap. Results From August 2020 to June 2021, 33 physicians and 143 patients (1 male) completed the survey. Average age was 49.72 years (SD = 10.95) for patients and 46.16 years (SD = 11.04) for oncologists. Respondents were (patients and oncologists, respectively) White (71%, 39%), Black (2%, 1%); and not Hispanic (71%, 82%). Over half of the patients (56%) reported having a bachelor’s degree and above and private insurance (58%). Half (55%) reported metastatic breast cancer; 85% having received treatment within the past year. About 56% reported being presented with an option to switch from biologic trastuzumab to biosimilar and 63% reported having switched. Of those who reported a switch, 40% received no prior notification. Using a scale of 0 (Disagree)-100 (Agree), we administered 13 matching questions to oncologists and patients about their experience (and perspective) with trastuzumab biosimilars. Patients reported lower ratings than oncologists, t(160) = 3.74, p = .006 (patients: M = 43.74, SD = 18.94; oncologists: M = 56.66, SD = 11.50). Smaller proportion of patients than oncologists responded positively (a score of &amp;gt;50) to all but 1 item (Table). About 44% of patients reported learning more about biosimilars through self-directed learning and 41% reported wanting more time to discuss with oncologist, achieving a better understanding of biosimilars (39%) and having access to printed materials (30%) and specifically, ones that are user-friendly (18%). Conclusions These findings highlight a discrepancy between patient-reported experiences and oncologist perceptions of the patient experience. Our findings suggest that lack of adequate information is a challenge not only to the uptake of trastuzumab biosimilars, but to the patient-oncologist relationship. There is a need for effective and tailored education for both oncologists and patients to facilitate communication regarding trastuzumab biosimilars, and to assure patients of safety and efficacy. % respondents with scores of &amp;gt; 50 (0 (Disagree) - 100 (Agree))Patients (n = 143)Oncologists (n = 33)My oncologist explained a switch to biosimilar trastuzumab in a way that was easy to understand42%58%I feel/felt involved in this treatment decision to choose a biosimilar trastuzumab for me17%18%I trust my oncologist in making the right decision to choose a biosimilar trastuzumab for me63%67%I trust my insurance company in making the right decision to require biosimilar trastuzumab instead of Herceptin9%12%I trust my hospital/center in making the right decision to require biosimilar trastuzumab instead of Herceptin41%44%I was given the opportunity to ask questions about a switch to biosimilar trastuzumab35%59%I was given adequate resources on biosimilar trastuzumab to feel comfortable with a switch18%33%My cancer is/will be treated as effectively with biosimilar trastuzumab as with Herceptin43%79%I understand the reason for switching to biosimilar trastuzumab43%39%This treatment switch to biosimilar trastuzumab DOES NOT make me worried24%41%I have emotionally adjusted to this treatment switch that wasnt due to cancer progression or quality of life issues41%42%I DO NOT worry more about my treatment success since this switch to a biosimilar trastuzumab29%33%Switching to a biosimilar trastuzumab is a minor change to my cancer care37%67%Note: Presented are patient-framed questions. Oncologist questions were reframed accordingly. Citation Format: Elizabeth Lerner Papautsky, Martha Carlson, Maryam Lustberg. The patient-centered paradox: A US-based survey of physician- and patient-reported experiences with biosimilar trastuzumab [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-13-13.

Working alliance and attachment orientations in the patient-oncologist relationship.

Accumulating research suggests that the working alliance (WA) is a key component in the patient-oncologist relationship. Attachment theory provides a useful framework for understanding this alliance within the oncological setting, where patients' attachment systems are often activated. This study examined the association between attachment orientations of both dyad members (i.e., patient and oncologist) and patients' WA experience. It also probed whether this link was mediated by patients' attachment-related attitudes towards the oncologist, using a recently developed measure. Oncologists and their respective patients (N=113: 103 patients, 10 oncologists) were sampled at oncological clinics. Eligible patients filled out online measures of the WA, attachment-related attitudes, and attachment orientations. The later was also completed by oncologists. Structural equation modeling demonstrated that both patients' and oncologists' avoidant attachment orientation inversely predicted patients' WA experience, via patients' experience of feeling unsupported by their oncologists. Findings suggest that attributes of both members of the patient-oncologist dyad are related to patients' WA experience, and that attachment-related attitudes towards oncologists occur within this relationship. Oncologists' understanding of patients' unique attachment behaviors, as well as their own such behaviors, could improve cancer patients' quality of care and illness outcomes. Results represent another step forward in fully exploring whether oncologists can serve as attachment figures for their patients.

Perception of patients regarding telemedicine at times of COVID-19: Did they miss the personal touch?

260 Background: The patient-oncologist relationship is cultivated from the first clinic visit, trust and assurance established throughout the follow up period until the end of life. In March 2020, with the break of the COVID-19 pandemic, social distancing restrictions were implement throughout Israel. The adoptions of telemedicine services were incorporate as a response at our institution. Almost all ambulatory activity in the oncology division in Tel Aviv Medical Center was converted to telemedicine services. Several studies report favorable results regarding patient preference and cost effectiveness of telemedicine. Methods: We conducted a telephone interview questionnaire assessing patient satisfaction. Inclusion criteria included solid tumor patients over 18 years who utilized the telemedicine platform at Tel Aviv Sourasky Medical Center between March 2020 - May 2020. We aimed to evaluate patient's perspectives and preferences regarding telemedicine and assess whether this virtual communication affects the patient-doctor relationship. Results: Following the COVID-19 outbreak, 400 telephone calls were made to patients, 100 patients agreed to participate and surveyed. Fifty-two percent were female. The majority of patients independently downloaded the telemedicine application and did not encounter technical constraints (67%). Family members and friend attended 45% of telemedicine visits. Patients cancer diagnosis included colorectal cancer (47%), breast cancer (18%), genitourinary cancer (18%), sarcoma (9%) lung malignancies (6%), gynecological cancer (1%) and CNS tumors (2%). Visit intent included post-treatment follow up (40%), active treatment follow (53%), and first visit intake (7%). The majority of patients felt their emotional needs were met (88%) and felt that their treatment was not harmed due to absence of a physical visit (84%). Almost all patients (99%) felt their privacy was maintained. Ninety-five percent of patients affirmed that the virtual visit relieved their worries regarding treatment interruption. Importantly, 75% of patients affirmed their interest to continue telemedicine regardless of COVID-19 pandemic. Conclusions: Telemedicine is an acceptable platform that may replace follow up visits without comprising patients’ experience. Our data call for research and development of tools enabling long-term implementation of remote telemedicine and assess the patient-physician relationship and quality of care among oncology patients.

Adolescent and Young Adult Cancer Patients' Experiences With Treatment Decision-making.

Adolescents and young adults (AYAs) with cancer generally want to engage in decision-making but are not always able to do so. We evaluated cancer treatment decision-making among AYAs, including decisional engagement and regret. We surveyed 203 AYA patients with cancer aged 15 to 29 (response rate 74%) treated at a large academic center and their oncologists. Patients were approached within 6 weeks of diagnosis and asked to report decision-making preferences and experiences (Decisional Roles Scale) and the extent to which they regretted their initial treatment decision (Decisional Regret Scale) assessed at baseline and 4 and 12 months later. A majority of AYAs (58%) wanted to share responsibility for decision-making with oncologists; half (51%) preferred limited involvement from parents. Although most AYAs held roles they preferred, those who did not reported holding more passive roles relative to oncologists (P < .0001) and parents (P = .002) than they desired. Nearly one-quarter of patients (24%; 47 of 195) experienced regret about initial cancer treatment decisions at baseline, with similar rates at 4 (23%) and 12 (19%) months. In a multivariable model adjusted for age, decisional roles were not associated with regret; instead, regret was less likely among patients who trusted oncologists completely (odds ratio 0.17 [95% confidence interval 0.06-0.46]; P < .001) and who reported that oncologists understood what was important to them when treatment started (odds ratio 0.13 [95% confidence interval 0.04-0.42]; P < .001). Nearly one-fourth of AYA patients expressed regret about initial treatment decisions. Although some AYAs have unmet needs for decisional engagement, attributes of the patient-oncologist relationship, including trust and mutual understanding, may be most protective against regret.

Characterizing Perceptions Around the Patient-Oncologist Relationship: a Qualitative Focus Group Analysis.

The purpose of the current study was to characterize the experiences of cancer patients and their caregiver/family members around their relationship with their oncologist, health care team, and the hospital environment. Participants were recruited from The Ohio State University Comprehensive CancerCenter. Participant sociodemographic factors were assessed. Focus groups were moderated and recordedby two members of the research team using a semi-structured interview format. The audio recordings were transcribed and uploaded to NViVO 11 for analyses. Four focus groups were conducted with 25 participants. The mean age of participants was 58.4years (SD = 15.1, range 26.0-76.0). Participants who were identified as patients (84%) reported different malignancy types including breast (56%), gynecologic (16%), skin (6%) oral (6%), and non-Hodgkin's lymphoma (6%). Three major themes that emerged around the patient-oncologist relationship, include (1) choosing a physician and health care location, (2) relationship with the physician, health care team, and hospital environment; and (3) patient engagement and decision-making. Subthemes highlighted the importance of the flexible communication behaviors and trustworthiness of the oncologist, and the impact of other health care team members. Patients also reported the desire to be engaged in making treatment-related decisions and to include the caregiver/spouse in all stages of cancer care. Understanding the experience of cancer patients in a relationship with their oncologist in the context of the health care team and health care environment will be an important area of future research to provide optimal, tailored patient-centered cancer care.

A systematic review of the methods utilised to measure the relationship between cancer patients and oncologists: Implications for future research and practice

The patient-physician relationship is a critical component of patient-centred health care. The patient-oncologist relationship is particularly important due to the uncertainties that surround treatment of cancer. The goal of the current review was to summarise current methodological approaches to studying the relationship between cancer patients and oncologists. A systematic review using PsychInfo, Ebsco, PubMed and Google Scholar was performed using combinations and variations of the MESH terms: "relationship," "doctor-patient," and "oncology." The included studies explicitly measured the "relationship" as an independent or dependent variable. Data were extracted and analysed. The 13 studies included in the review were published from 2004 to 2018. There was little agreement between studies on the definition of the patient-oncologist relationship. Trust was most frequently measured, but methods varied. Most studies evaluated the patient perspective (n=10). The few studies that considered the oncologist perspective did not measure their perception of the relationship. The current review demonstrates that current approaches used to assess the patient-oncologist relationship are inconsistent. These differences may limit our understanding of patient needs in current research and practice. Future research should focus on the use of a relational lens as a theoretical framework to assess the patient-oncologist relationship.

Les thérapies non conventionnelles dans la pratique de la cancérologie : quelles réponses apporter aux patients ?

Complementary and Alternative Medicine (CAM) is very popular and cancer patients are not immune to this phenomenon. On one hand alternative therapies, claim to fight directly against the disease, and on the other hand complementary therapies offer to help the patient, also conventionally followed, to live with his disease. Faced with the questions of a patient, a lax posture can expose the patient to risks, intolerance can alter the patient-oncologist relationship and confirm the patient in hazardous choices. It is therefore important to ask patients about the use of such therapies, early in their care. Doctors entering these discussions have both evidence-based recommendations and quality online resources. However, there are cases where information is missing and caution is needed. This evolution encourages us to adapt our practices and our organizations.

The relationship between psychosocial factors in the patient–oncologist relationship and quality of care: A study of breast cancer patients

ABSTRACTThis study examined the relationship between psychosocial factors in the patient–oncologist relationship and aspects of care among women with breast cancer. Breast cancer patients (N = 118) completed a questionnaire about their relationship with their oncologist, their treatment, and their health. While trust was related to several positive outcomes, physician supportiveness was most strongly related to satisfaction with care, and health care access was most strongly associated with general health. The results suggest that the addition of supportiveness and healthcare access to trust provide a more complete picture of patients' health outcomes.

Characterizing terminal oncology ICU hospitalizations.

167 Background: Twenty-five percent of Medicare cancer beneficiaries use the ICU in the last month of life, and 8% of cancer patients expire there. Cancer patients who die in the ICU have worse quality of life compared with those who die at home. Terminal ICU hospitalizations also come at high financial cost, accounting for 80.2% of all terminal hospitalization costs. Our hypothesis is that a significant number of oncology patients suffer avoidable terminal ICU hospitalizations. By better characterizing these hospitalizations, we will provide the knowledge backbone for future interventions. Methods: Using data from the University of Chicago (UC) cancer registry, we identified patients who died in UC adult ICU’s in FY2013. Of the 1,388 oncology deaths, 115 were in the ICU. Of those, 73 were established patients having had at least one visit with a UC oncologist. We performed a chart abstraction to identify patient, clinical, and hospitalization characteristics. Results: The average age of this patient population was 64 years and 71% were men. Solid and hematologic malignancies comprised 71% and 29%, respectively. Of the solid malignancy patients, 54% had metastatic disease. The average duration of the patient-oncologist relationship was 693 days, and 77% had their last oncology appointment within 2 months of index hospitalization. The ECOG performance status was ≥ 2 prior to admission in 51% of patients. These patients had an average of 3 hospitalizations and 15 outpatient visits in the year prior to death. Eighty-one percent did not have advance directives and 86% did not have an outpatient palliative care consult. The average duration in the ICU was 8 days, during which 95% did not have an inpatient palliative care consult, 79% were intubated, and 38% had resuscitation attempted. Conclusions: Most cancer patients who died in the ICU had an advanced stage malignancy and/or poor clinical status prior to admission. In addition, a significant number received intubation and resuscitation. Despite evidence of adequate interaction with the healthcare system, most patients had not had a palliative care consult or advance directives. This study will allow for further exploration of the avoidability of terminal oncology ICU hospitalizations to inform future interventions.

Contributors to nonadherence and nonpersistence with endocrine therapy in breast cancer survivors recruited from an online research registry.

Rates of adherence and persistence with endocrine therapy regimens (i.e., tamoxifen, aromatase inhibitors) by breast cancer survivors are suboptimal, with negative implications for prognosis. This study identified potential contributors to nonadherence and nonpersistence. From an online breast cancer research registry (Army of Women) including approximately 51,000 breast cancer survivors, we recruited 1,371 women who currently were taking endocrine therapy and 94 nonpersisters (i.e., diagnosed during the prior 5years and on endocrine therapy within the prior 12months, but no longer taking it). Participants completed an online questionnaire assessing demographic/medical characteristics, general and cancer-related psychosocial variables (i.e., depressive symptoms, anxiety, patient-oncologist relationship quality, cancer recurrence worry, general symptoms), and endocrine therapy-specific variables (i.e., endocrine therapy-related symptoms, perceived endocrine therapy necessity, long-term therapy use concern, endocrine therapy-related emotions). Two weeks later, current users were re-contacted to complete an endocrine therapy adherence measure. In a final regression model, patient-reported nonadherence among current users was significantly associated with lower financial status, a prior switch in endocrine therapies, a poorer relationship with the oncologist, and lower perceived need for and more negative emotions regarding endocrine therapy (adjusted R (2)=0.15, P<0.001). In a final logistic regression model, endocrine therapy nonpersisters were significantly more likely than current users to report depressive symptoms, as well as more negative emotions and lower positive emotions related to endocrine therapy (adjusted R (2)=0.10, P<0.001). In addition to demographic/medical variables, several potentially modifiable psychosocial characteristics are likely to contribute to endocrine therapy nonadherence and nonpersistence.

Closing the Patient–Oncologist Communication Gap: A Review of Historic and Current Efforts

Effective communication is essential in developing any relationship--this is particularly true between oncologists and their patients. The patient-oncologist relationship is one of the most delicate in medicine, and given the strong emotions associated with cancer, successful communication plays a paramount role in the wellbeing of patients and oncologists. Significant advances to close the communication gap have occurred over the past several decades, largely by addressing deficiencies in the various stages of an oncologist's lengthy training: undergraduate medical education, residency and fellowship, and continuing medical education. Stemming from several milestones achieved by highly motivated groups of individuals, including the creation of consensus statements and guidelines by communication education experts, progress has been made to improve patient-oncologist communication. This progress is marked by the development of evidence-based communication skills training programs, such as Oncotalk and Comskil, in addition to the creation of distant-learning modalities, such as the Studying Communication in Oncologist-Patient Encounters trial. This review article outlines the history of communication education during medical education and training, and brings to light more recent efforts to promote competent, communication-minded physicians necessary for effective cancer care.

Cancer‐related self‐efficacy following a consultation with an oncologist

When receiving a cancer diagnosis, patients are often faced with psychological distress and loss of control. As a result, their psychological well-being may be influenced by their perceived ability to cope with disease-related and treatment-related challenges. Research indicates that the patient-oncologist relationship may have an impact on patients' self-efficacy. The aim was to examine predictors of self-efficacy following a consultation in an oncology outpatient clinic and the predictors of change. A total of 226 patients (mean age: 61 years, 40% male) attending an oncology outpatient clinic completed questionnaires before and after a consultation including the Hospital Anxiety and Depression Scale, two domain-specific self-efficacy scales measuring coping self-efficacy and decision self-efficacy, the Physician-Patient Relationship Inventory, and the Information Satisfaction Questionnaire. While most patients experienced an increase in self-efficacy following the consultation, some patients experienced lower self-efficacy post-consultation. In the multivariate analysis, depressive symptoms emerged as a relatively strong predictor of both coping self-efficacy and decision self-efficacy, whereas marital status was a significant predictor of coping self-efficacy, and satisfaction with information significantly predicted decision self-efficacy. No significant associations were found between self-efficacy and the patients' ratings of the physician-patient relationship. Depression seems to be a potential risk factor for lower cancer-related self-efficacy, following an oncologist consultation. By identifying patients who exhibit symptoms of depression, health professionals can increase their attention on empowering these patients. Furthermore, our results suggest that patients' experience of self-efficacy depends on what particular challenges they have to overcome.

Effect of patient and patient–oncologist relationship characteristics on communication about health‐related quality of life

To test the effects of patient and patient-oncologist relationship factors on the time spent communicating about health-related quality of life (HRQOL) during outpatient clinic encounters between oncologists and their patients with advanced cancer. Using mixed methods, we coded for duration of HRQOL talk in a subset of audio-recorded conversations from the Study of Communication in Oncologist-Patient Encounters (SCOPE) Trial. Multivariable linear regression modeling was used to investigate the relationship between duration of HRQOL talk and gender concordance, race concordance, patient education status, patient marital status, and length of the patient-oncologist relationship (i.e. number of previous visits). Sixty-six encounters were analyzed that involved 63 patients and 34 oncologists. Patients were more likely to be female (51%), white (86%), married (78%), and possess a college or more advanced degree (33%). Most oncologists were male (82%) and white (82%). Mean ages were 58.8 years for patients and 44.9 years for oncologists. Regression results showed that the number of a patient's previous visits with their oncologist was significantly associated with a longer duration of HRQOL talk during their audio-recorded clinic visit. The remaining independent variables, gender concordance, race concordance, patient education status, and patient marital status were not significant predictors of duration of HRQOL talk. Our findings suggest that length of the patient-oncologist relationship is related to duration of HRQOL talk. Improvements in HRQOL communication may best be achieved through efforts directed at those in earlier stages of the doctor-patient relationship.

A Delicate Dance: Negotiating the Doctor-Patient Relationship During Cancer Treatment

Abstract The author reflects on the intricate dance of the patient–oncologist relationship experienced during her cancer journey.

Determinants of trust in the patient–oncologist relationship

The relationship between the patient and physician is at the heart of good medical care, and trust is an essential component of this relationship. To enable the oncologist to better form a trusting relationship with the patient, this article describes four factors that influence patient trust. Thematic literature review and a clinical vignette. The authors discuss four factors that influence patient trust. These factors are whether and how the oncologist (1) minimizes the potential for shame and humiliation during the medical encounter, (2) manages the power imbalance between doctor and patient without abuse or misuse, (3) demonstrates to the patient an appreciation of how he or she is suffering from experience of cancer, and (4) demonstrates to the patient how he or she is suffering from the treatment provided by the oncologist. The authors illustrate these factors with a clinical vignette. The cancer patient is best cared for by an oncologist who can not only understand disease and treat medical problems, but also accompany the patient through the illness experience. This requires an appreciation of the challenges to trust that are inherent in the special characteristics of the patient-physician interaction.