Fear and forget: how anxiety impacts information recall in newly diagnosed cancer patients visiting a fast-track clinic

Abstract

Introduction: One-day fast track programs for cancer diagnostics and treatment planning are increasingly being implemented in health care. Fast-track programs are highly effective at reducing waiting times, and thus well received by patients and healthcare providers. However, these programs may also burden patients, as patients generally receive a lot of information from multiple healthcare providers within a short time span. This might increase anxiety and negatively impact recall of medical information in newly diagnosed patients. This study examines whether anxiety influences information recall at the moment of diagnosis, and whether this relation differs for younger and older patients. Methods: Data were collected from 78 colorectal cancer patients visiting a one-day fast-track multidisciplinary outpatient clinic. All consultations that took place were recorded on a video. Anxiety was measured at baseline (T1) and immediately after consultations (T2) with the STAI-6. Information recall was assessed by telephone within 36-48 hours after patients' visit (T3) using open questions. Results: After consultations (T2), 32% of patients experienced clinical anxiety levels. Patients recalled $60% of medical information (T3). Information recall was negatively impacted by anxiety (b ¼-.28, p ¼ .011), and negatively related to higher age (b ¼-.23, p ¼ .031), and lower education level (b ¼ .27, p ¼ .013). Although older patients (M ¼ 53.99) recalled 11% less information than younger patients (M ¼ 64.84), age was not related to anxiety and did not moderate the anxiety-recall relationship. Conclusion: High levels of anxiety after receiving a cancer diagnosis negatively influence how much information patients remember after visiting a one-day fast-track clinic. This calls for interventions that may reduce patients' anxiety as much as reasonably possible and support patients' information recall. Researchers, practitioners, and hospitals are encouraged to continue exploring ways to optimize information provision to cancer patients in current modern healthcare.

Tailored Web-Based Information for Younger and Older Patients with Cancer: Randomized Controlled Trial of a Preparatory Educational Intervention on Patient Outcomes

“…What makes these findings particularly noteworthy is that in this study, we did not find a relationship between anxiety during consultation and information recall from the consultation. In a previous observational field study among the same patient population, at the same outpatient clinic, but without a preparatory website intervention, anxiety during consultation negatively predicted information recall from consultations [6]. Interestingly, in this RCT, anxiety was not found to be a barrier for information recall.…”

“…Knowledge acquired from the website was measured using the protocol of the Netherlands Patient Information Recall Questionnaire (NPIRQ) via telephone interviews [6,47]. We asked patients 12 standardized open questions based on the website content (eg, about the goal and course of the fast-track program and which medical specialists they will see).…”

“…The first author (MHN) coded all answers. A second coder (MA) coded answers from 14 participants from a different dataset with the exact same code book (mean kappa=0.816; P <.001) [6].…”

“…In general, older patients are less likely to express their information needs or preferences and participate less actively during consultations [2,3]. Moreover, they generally experience lower self-efficacy in obtaining relevant information from their provider [4] and have more difficulty remembering information from consultations than younger patients [5,6]. Therefore, particularly, older patients could benefit from support by communicating with providers.…”

“…The different processes explaining knowledge acquisition and information recall can be related to a patient’s motivation (eg, website involvement) or ability (eg, communication self-efficacy) to process information. Although ELM and LC4MP are useful frameworks in understanding how mode tailoring can enhance motivation and ability to process information, how these processes translate to specific variables explaining knowledge and recall of information in the cancer context has only been briefly explored [5,6,40]. For instance, Bol et al used ELM and LC4MP to identify motivation- and ability-related factors in the literature deemed relevant for processing of online cancer information [40].…”