Why Do Cancer Patients Have Difficulties Evaluating the Need for a Second Opinion and What Is Needed to Lower the Barrier? A Qualitative Study

Abstract

Background: Requesting a second opinion (SO) is common in oncology. The reasons and barriers for patients not seeking an SO have yet been to be investigated. Why do patients have difficulties evaluating their need for an SO and what could be done to minimize these barriers? Patients and Methods: A 2-stage qualitative study was conducted. 1) Participants were studied in 3 focus groups (FGs). The participants themselves analyzed and then grouped their statements into defined categories. 2) Results of the FGs were discussed with 7 experts from different professional backgrounds. The interviews were unstructured and detailed in the protocol. The statements underwent thematic analysis. Results: The following 4 main barriers were identified: 1) state of shock, 2) pressure of time, 3) sense of excessive demands and uncertainty triggered by information overload, 4) fear of jeopardizing the patient-physician relationship. The following 4 main suggestions for minimizing the barriers were identified: 1) written patient information, 2) improvement of communication, 3) patient empowerment (PE), 4) holistic approach. Conclusion: These barriers incapacitate the patients from evaluating the need for an SO. To minimize the barriers, PE, self-management support and shared decision making is recommended. While the implementation of these concepts advances, patients can be empowered by psycho-oncological assistance.

Analysis of Oncological Second Opinions in a Certified University Breast and Gynecological Cancer Center Regarding Consensus between the First and Second Opinion and Conformity with the Guidelines

“…The biggest barrier keeping patients from seeking an oncological second opinion is the fear of compromising the patient-physician relationship. On the one hand, patients want to get the best possible cancer treatment but, on the other hand, they do not want to jeopardize the relationship with their attending physicians by seeking a second opinion and appearing to question their competence [35, 36]. It is our opinion that patients should have the option of an oncological second opinion being openly offered to them by the attending physician.…”

Analysis of motives and patient satisfaction in oncological second opinions provided by a certified university breast and gynecological cancer center

“…Although the implementation of the Law on Enhancing Care Provision under Statutory Health Insurance, at least in the first phase, was initially related to second opinions particularly in non-oncological surgery, the German Cancer Society (DKG) launched a pilot project in April 2019 on medical second opinions for patients with intestinal and prostate cancer who wanted a qualified second opinion. These patients are able to benefit from the expertise of centers with DKG certification [23]. These points support the importance of oncological second opinions-a topic that is attracting greater social attention and becoming a focus in health-care policy.…”

Experiences of patients with cancer at health care facilities in Japan: results from a nationwide survey

“…For example, fewer patients were asked to seek a second opinion. Because many patients may fear that seeking second opinion may offend their doctors [ 14 ], such patients should be informed of this option by their doctors. During treatment, most patients did not feel comfortable about communication with medical staff; less than half of patients felt comfortable talking to the medical staff besides their doctors or consult with medical staff about their physical and psychological distress.…”