Analysis of Patient-Physician Concordance in the Understanding of Chemotherapy Treatment Plans Among Patients With Cancer

Almalki, Hani; Absi, Ahmed; Alghamdi, Abdulrahman; Alsalmi, Mohammed; Khan, Muhammad Anwar

doi:10.1001/jamanetworkopen.2020.0341

Cited by 17 publications

(18 citation statements)

References 25 publications

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“…We found that many patients in both components of our study felt they understood their MTB treatment recommendations, which is contrary to findings in literature [34,[50][51][52]. Patients in our study reported that their treatment recommendations from MTB were clear and useful, and that they liked being included in the decision-making process.…”

Section: Discussioncontrasting

confidence: 99%

Using Telemedicine to Facilitate Patient Communication and Treatment Decision-Making Following Multidisciplinary Tumor Board Review for Patients with Hepatocellular Carcinoma

Choi

Sada

Sansgiry

et al. 2022

J Gastrointest Canc

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Background and Aims A rapid increase in the use of telemedicine for delivering healthcare has occurred since the onset of the Covid-19 pandemic. There is evidence for using telemedicine to facilitate cancer care delivery for patients with hepatocellular carcinoma (HCC). Examining how telemedicine can be used to communicate multidisciplinary tumor board (MTB) recommendations for HCC has not been studied. This study has two specific aims: (1) to evaluate the patient perspective of the MTB review process and identify best strategies for communicating treatment recommendations for HCC and (2) to pilot test a telemedicine intervention following MTB review to assess patient feasibility and satisfaction with using telemedicine to facilitate treatment decision-making and treatment referral. Methods We conducted a mixed-methods study. First, semi-structured qualitative interviews were conducted among patients diagnosed with HCC who were discussed in MTB review at one of three VA Medical Centers (VAMC). We collected information about the MTB process from the patient perspective and identified strategies for improving communication and delivery of care. Rapid qualitative analysis was used to inform intervention development. Using our qualitative data, a MTB telemedicine pilot intervention was developed and implemented to assess the feasibility of using this approach for patients with HCC. Results Almost all patients (94%) in the pilot study would recommend telemedicine to other patients with HCC, and half of the patients (50%) preferred telemedicine over in-person visits. Many patients (81%) found communication through telemedicine an acceptable platform to deliver difficult cancer information. Overall, patients felt they understood their treatment recommendations and found them clear and useful. Further, patients reported that they enjoyed being included in the decision-making process and appreciated being able to have family members easily join them for the telemedicine visit. Conclusions Using telemedicine to communicate treatment recommendations following MTB review was found to be feasible and an acceptable alternative to an in-person visit for patient with HCC. Future studies could include expanding this approach for communicating MTB recommendations to patients with other types of cancers.

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Section: Discussioncontrasting

confidence: 99%

Using Telemedicine to Facilitate Patient Communication and Treatment Decision-Making Following Multidisciplinary Tumor Board Review for Patients with Hepatocellular Carcinoma

Choi

Sada

Sansgiry

et al. 2022

J Gastrointest Canc

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“…Although patients reported that they discussed their treatment goals in 82% of the cases with their oncologists and oncologists in 91% of the cases with the patient, we found overall low concordances between patients' and oncologists' goals: between 24% for 'decrease in tumor growth' and 37% for 'quality of life.' A recent study by Almalki et al 26 found that only 13.7% of patients had full concordance with their physicians regarding the aspects of their treatment plans. However, this study consisted of a heterogeneous cancer population.…”

Section: Discussionmentioning

confidence: 98%

What Goals Do Patients and Oncologists Have When Starting Medical Treatment for Metastatic Lung Cancer?

Mieras

Pasman

Klop

et al. 2021

Clinical Lung Cancer

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It is unknown what treatment goals patients and oncologists have before starting systemic treatment. In total, 266 patients with metastatic lung cancer and their prescribing oncologists (n [ 23) were included. Patients and oncologist set quality of life, life prolongation, decreased tumor, and cure as treatment goals, but concordances of treatment goals were low. Clear communication about treatment goals should be integrated into clinical care. Background: Metastatic lung cancer is an incurable disease that can be treated with systemic therapy. These treatments might prolong survival and reduce symptoms, but they may also cause serious adverse effects. We studied the treatment goals of patients with metastasized lung cancer and their oncologists before starting systemic therapy, concordance between patients' and oncologists' goals, and feasibility of these goals. Patients and Methods: This research was conducted between November 2016 and April 2018 in 1 academic and 5 nonacademic hospitals across the Netherlands. A total of 266 patients with metastatic lung cancer and their prescribing oncologists (n ¼ 23) filled out a questionnaire about their treatment goals and the estimated feasibility of these goals before treatment was started. Additional interviews were conducted with patients and oncologists. Results: Patients and oncologists reported quality of life (respectively, 45% and 72%), life prolongation (45% and 55%), decrease in tumor size (39% and 66%), and cure (19% and 2%) as treatment goals. The interviews showed that the latter appeared to be often as motivation to stay alive. Concordances between patients' and oncologists' treatment goals were low (ranging from 24% to 33%). Patients had slightly higher feasibility scores than oncologists (6.8 vs. 5.8 on a 10-point scale). Educational level, age, religious views, and performance status of patients were associated with treatment goals. Conclusion: Patients and oncologists set various goals for the treatment they receive/prescribe. Low concordance might exist because different goals are set or because the patient misunderstands something. Clear communication about treatment goals should be integrated into clinical care.

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“…The concept of concordance underpins patient centred care—although the descriptive term receives scant reference in studies. In the healthcare setting, concordance is a mutual understanding or agreement concerning treatment between physician and patient [ 1 , 102 – 104 ]. A lack of concordance is shown to result in expectations that differed between patient and physician.…”

Section: Concordancementioning

confidence: 99%

“…By way of example, in a comprehensive study concerning oral cancer adherence in older adults the term concordance receives no reference and is seen in only one of eighty-four citations [ 31 ]. In a report into chemotherapy treatment plans, only a relatively low number of patients were in full concordance with their physician regarding chemotherapy treatment plans [ 102 ]. This was due to a ‘suboptimal understanding of aspects of their chemotherapy treatment plans’ [ 102 , p.11].…”

Section: Concordancementioning

confidence: 99%

“…In a report into chemotherapy treatment plans, only a relatively low number of patients were in full concordance with their physician regarding chemotherapy treatment plans [ 102 ]. This was due to a ‘suboptimal understanding of aspects of their chemotherapy treatment plans’ [ 102 , p.11]. In that study there were anomalies, such as ‘only 57.0% of hospitalized patients reported that they understood the potential adverse effects of their medications on discharge, physicians [however] believed that 89% of their patients understood these effects’ [ 102 , p.11].…”

Section: Concordancementioning

confidence: 99%

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When can cancer patient treatment nonadherence be considered intentional or unintentional? A scoping review

2023

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Background Treatment nonadherence in cancer patients remains high with most interventions having had limited success. Most studies omit the multi-factorial aspects of treatment adherence and refer to medication adherence. The behaviour is rarely defined as intentional or unintentional. Aim The aim of this Scoping Review is to increase understanding of modifiable factors in treatment nonadherence through the relationships that physicians have with their patients. This knowledge can help define when treatment nonadherence is intentional or unintentional and can assist in predicting cancer patients at risk of nonadherence and in intervention design. The scoping review provides the basis for method triangulation in two subsequent qualitative studies: 1. Sentiment analysis of online cancer support groups in relation to treatment nonadherence; 2. A qualitative validation survey to refute / or validate claims from this scoping review. Thereafter, framework development for a future (cancer patient) online peer support intervention. Methods A Scoping Review was performed to identify peer reviewed studies that concern treatment / medication nonadherence in cancer patients—published between 2000 to 2021 (and partial 2022). The review was registered in the Prospero database CRD42020210340 and follows the PRISMA-S: an extension to the PRISMA Statement for Reporting Literature Searches in Systematic Searches. The principles of meta-ethnography are used in a synthesis of qualitative findings that preserve the context of primary data. An aim of meta-ethnography is to identify common and refuted themes across studies. This is not a mixed methods study, but due to a limited qualitativevidence base and to broaden findings, the qualitative elements (author interpretations) found within relevant quantitative studies have been included. Results Of 7510 articles identified, 240 full texts were reviewed with 35 included. These comprise 15 qualitative and 20 quantitative studies. One major theme, that embraces 6 sub themes has emerged: ‘Physician factors can influence patient factors in treatment nonadherence’. The six (6) subthemes are: 1. Suboptimal Communication; 2. The concept of Information differs between Patient and Physician; 3.Inadequate time. 4. The need for Treatment Concordance is vague or missing from concepts; 5. The importance of Trust in the physician / patient relationship is understated in papers; 6. Treatment concordance as a concept is rarely defined and largely missing from studies. Line of argument was drawn Treatment (or medication) nonadherence that is intentional or unintentional is often attributed to patient factors—with far less attention to the potential influence of physician communication factors. The differentation between intentional or unintentional nonadherence is missing from most qualitative and quantitative studies. The holistic inter-dimensional / multi-factorial concept of ‘treatment adherence’ receives scant attention. The main focus is on medication adherence / nonadherence in the singular context. Nonadherence that is unintentional is not necessarily passive behaviour and may overlap with intentional nonadherence. The absence of treatment concordance is a barrier to treatment adherence and is rarely articulated or defined in studies. Conclusion This review demonstrates how cancer patient treatment nonadherence is often a shared outcome. An equal focus on physican and patient factors can increase understanding of the two main types of nonadherence (intentional or unintentional). This differentation should help improve the fundamentals of intervention design.

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Analysis of Patient-Physician Concordance in the Understanding of Chemotherapy Treatment Plans Among Patients With Cancer

Cited by 17 publications

References 25 publications

Using Telemedicine to Facilitate Patient Communication and Treatment Decision-Making Following Multidisciplinary Tumor Board Review for Patients with Hepatocellular Carcinoma

Using Telemedicine to Facilitate Patient Communication and Treatment Decision-Making Following Multidisciplinary Tumor Board Review for Patients with Hepatocellular Carcinoma

What Goals Do Patients and Oncologists Have When Starting Medical Treatment for Metastatic Lung Cancer?

When can cancer patient treatment nonadherence be considered intentional or unintentional? A scoping review

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