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Patients with advanced cancer prefer face-to-face consultations
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Nearly three-quarters of patients with advanced cancer preferred doctors who communicated with them face-to-face while holding a notepad rather than repeatedly using a computer, according to the results of a randomized controlled study scheduled for presentation at the Palliative and Supportive Care in Oncology Symposium.
“Our research highlights a very important aspect of doctor-patient communication: how cancer patients perceive their doctors when they use an examination room computer during visits,” Ali Haider, MD, assistant professor of palliative, rehabilitation and integrative medicine at The University of Texas MD Anderson Cancer Center, said during a press conference. “Because patients with cancer often experience high physical and psychosocial symptoms, it is very important for doctors to monitor certain physical cues to gain knowledge about their patients’ well-being.”
Many physicians now use computer software programs in the exam room to manage electronic health records. Haider noted that as of 2015, as many as nine in 10 physicians reported computer use in the exam room, more than triple the rate in 2008.
Researchers theorized the lack of direct eye contact between doctors and patients might impair communication.
Researchers recruited 120 English-speaking adults (90% fully physically functional) with localized, recurrent or metastatic cancer and randomly assigned them to four equal-sized groups that viewed videos in different sequences. Conducted at an outpatient supportive care center, all participants watched two videos — each approximately 3 minutes in length — depicting a routine physician-patient clinical encounter.
Both videos had identical scripts in which doctors — portrayed by actors — used the same gestures, expressions and other nonverbal communication to minimize bias. In one video, the doctor performed the consultation holding a notepad. In the other, the doctor used an exam room computer during the consultation.
After viewing each video, participants completed a validated questionnaire rating the doctor’s communications skills, professionalism and compassion. Participants also rated their overall physician preference.
The doctors who held only a notebook during their consultations received higher median scores in compassion (9; interquartile range [IQR], 0-18 vs. 20; IQR, 6-28; P = .0003), communication skills (65; IQR, 54-70 vs. 54; IQR, 41-63; P = .0001) and professionalism (19; IQR, 5-20 vs. 14; IQR, 11-17; P = .013).
After watching the second video, 86 participants (72%) preferred face-to-face consultations over one in which the physician used a computer.
“Patients with advanced illnesses such as cancer perceived physicians who communicated face-to-face as more compassionate, professional and with better communication skills,” Haider said. “This study gives us a message that patients prefer their doctors give them undivided attention. Better communication can enhance patient trust and satisfaction.”
Researchers acknowledged that a younger population with higher computer literacy might produce a different result in a similar study and might be worthy subjects of a future study.
“We believe the results may be different if we chose a younger population or patients with high computer literacy,” Haider said. “This is probably a topic for future research. Our prime objective was to see the patient’s perception of electronic health records being in their care. We need more studies to better assess what patients’ perception are about different kinds of equipment in the exam room, including tablets and phones.”
The rapid uptake of electronic health records in oncology has given clinicians a large database for improved care, noted Andrew S. Epstein, MD, ASCO expert and medical oncologist at Memorial Sloan Kettering Cancer Center, who was not involved in the study.
“In an age of ubiquitous technology, this study is an important reminder of the need to address the potential for technology to interfere with the patient-clinician interface, which is a critical component of the relationship between these two parties,” Epstein said. “I agree more research is needed, but face-to-face communication seems, quite possibly, the preferred route, despite the pressures all clinicians have to search and document in the medical records.” – by Chuck Gormley
Reference:
Haider A, et al. Abstract 26. Scheduled for presentation at: Palliative and Supportive Care in Oncology Symposium; Oct. 27-28, 2017; San Diego.
Disclosures: The authors report no relevant financial disclosures. Epstein reports a financial relationship with UpToDate.