Clinician Perspectives on Communication and Implementation Challenges in Precision Oncology

Abstract

Aim: To describe patient communication challenges encountered by oncology clinicians, which represent a fundamental barrier to implementing precision oncology. Materials & methods: We conducted three focus groups including breast, melanoma and thoracic oncology clinicians regarding their precision oncology communication experiences. Transcripts were reviewed and coded using inductive thematic text analysis. Results: We identified four themes: varied definitions of precision oncology exist, clinicians and patients face unique challenges to precision oncology implementation, patient communication challenges engendered or heightened by precision oncology implementation and clinician communication solutions and training needs. Conclusion: This study elucidated clinicians’ perspectives on implementing precision oncology and related communication challenges. Understanding these challenges and developing strategies to help clinicians navigate these discussions are critical for ensuring that patients reap the full benefits of precision oncology.

Understanding communication between patients and healthcare professionals regarding comprehensive biomarker testing in precision oncology: A scoping review

“…18,19,28,36 Several overarching challenges surrounding cBTrelated communication were identified: the patients' general distress due to cancer diagnosis, 12,19,21,37,38,40,41 limited health literacy and lack of patients' understanding of genomic concepts, 12,17,19,20,37,38,42,43 uncertain significance of some cBT results, 38,40,44 a mismatch between high patient expectations and perceived benefit of cBT versus actual testing outcomes 12,20,33 and a potential lack of actionable alterations and/or therapeutic options based on a patient's genomic profile. 12,20,33,37,41,43 Also, additional costs and potential insurance issues were challenging for patients interested in undergoing cBT. 19,20,26,35,37 These concerns of potential health and social discrimination were shared by HCPs surveyed in three other studies.…”

“…31,43 Patients' families and caregivers were reported to significantly influence the decision-making process and cBT uptake. 20,45,46,49 Oncologists surveyed in two studies faced different challenges involving patients and their families in cBT-related discussions depending on their practice characteristics. 49,50 Furthermore, time and resources needed to realize cBT-related discussions were barriers for both oncologists and patients, 20 while the aspect of cBT costs as a barrier for patients was recognized in one original USAbased study and one systematic review.…”

“…12,20,33,37,41,43 Also, additional costs and potential insurance issues were challenging for patients interested in undergoing cBT. 19,20,26,35,37 These concerns of potential health and social discrimination were shared by HCPs surveyed in three other studies. 18,45,46 Additionally, the included studies often did not specify the timepoints (e.g., days/weeks after diagnosis, pre-or post-surgery or first-line therapy) and manner (e.g., in-person or via telephone consultation, type of appointment, used language, time spent) in which HCPs communicated with patients regarding cBT.…”

“…20,45,46,49 Oncologists surveyed in two studies faced different challenges involving patients and their families in cBT-related discussions depending on their practice characteristics. 49,50 Furthermore, time and resources needed to realize cBT-related discussions were barriers for both oncologists and patients, 20 while the aspect of cBT costs as a barrier for patients was recognized in one original USAbased study and one systematic review. 46,48 Yabroff et al found that frequency of cBT cost discussions depended on oncologists' specialization and experience with cBT, 48 while Vetsch et al reported on HCPs reluctance to offer or order cBT due to its high out-of-pocket costs.…”

Organoids: The current status and biomedical applications

“…Organoids have shown great potential in the field of precision medicine, which aims to tailor medical treatments to individual patients based on their specific genomics and metabolomics. 255 By providing a more physiologically relevant and personalized model of human organs or tissues, organoids can be used to predict individual patient responses to drugs and other treatments. 256,257 One potential application of organoids in precision medicine is in the development of personalized cancer treatments.…”