Audiotapes and letters to patients: the practice and views of oncologists, surgeons and general practitioners

Abstract

Summary A range of measures have been proposed to enhance the provision of information to cancer patients and randomized controlled trials have demonstrated their impact on patient satisfaction and recall. The current study explored the practice and views of oncologists, surgeons and general practitioners (GPs) with regards to providing patients with consultation audiotapes and summary letters. In stage 1, 28 semi-structured interviews with doctors were conducted to provide qualitative data on which to base a questionnaire. In stage 2, 113 medical oncologists, 43 radiation oncologists, 55 surgeons and 108 GPs completed questionnaires. Only one-third of doctors had ever provided patients with a copy of the letter written to the oncologist or referring doctor, and one-quarter had provided a summary letter or tape. The majority of doctors were opposed to such measures; however, a substantial minority were in favour of providing a letter or tape under certain conditions. More surgeons and GPs (> two-thirds) were opposed to specialists providing a consultation audiotape than oncologists (onethird). Gender, years of experience and attitude to patient involvement in decision-making were predictive of doctors' attitudes. The majority of doctors remain opposed to offering patients personalized information aids. However, practice and perspectives appear to be changing.

Beliefs and practices of patients with advanced cancer: implications for communication

“…At odds are the practitioner's duty to truth telling and the patient's cognitive and emotional appraisal of bad news. Techniques for delivery of bad news are well documented in oncology (Sell et al, 1993;Girgis and Sanson-Fisher, 1995), but studies also recognise that information can be misunderstood or forgotten (Ptacek and Eberhardt, 1996;McConnell et al, 1999;Schofield et al, 2001). The use of audiotapes in medical consultations is a logical antidote to misunderstanding (Hogbin and Fallowfield, 1989;Damian and Tattersall, 1991;Deutsch, 1992;Dunn et al, 1993;McHugh et al, 1995) but, for patients with a poor prognosis, bad news can increase psychological distress (McHugh et al, 1995) and the potential for maladaptive responses.…”

“…Recent research has placed a considerable emphasis on effective communication of bad news (Fallowfield, 1993;Sell et al, 1993;Ptacek and Eberhardt, 1996) and numerous approaches have been recommended to evaluate and improve communication (Fallowfield, 1993;McConnell et al, 1999;Schofield et al, 2001). Yet relatively little attention has been paid as to what patients believe about what they are told and how they respond to bad news.…”

Consultation audio-tapes: an information aid, and a quality assurance and research tool

“…It is regrettable that surveys of Australian doctors' views on providing consultation audio-tapes have revealed a marked lack of enthusiasm [14]. If cancer patients and their consumer organisations are enthusiastic, I believe a publicity campaign would be likely to lead to more rapid provision of audio-tape facilities in cancer centres and consulting rooms.…”

“…Audio-tapes of oncology consultations have proved acceptable both to patients and to some doctors [14]. Patients receiving such audio-tapes report that they are useful both to themselves and to their families, report higher satisfaction with their medical communication, and in some studies demonstrate improved recall of facts presented during consultations.…”

Where have all the copy letters gone? A review of current practice in professional–patient correspondence

“…It has been suggested that letters should be dictated in front of patients [27], with patients reportedly appreciating this sense of openness [50]. In the field of cancer care it has been reported that audiotapes, either instead of or as well as copy correspondence can be helpful in some consultations [51]. Two studies describe the practice of writing separate letters to another health worker and to the patient [18,40].…”