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Nearly 60% of breast cancer diagnoses delivered by phone
The percentage of patients with breast cancer who receive their diagnosis over the telephone has increased considerably in the past decade, according to a study conducted by researchers from University of Missouri.
Jane A. McElroy, PhD, professor of family and community medicine at MU School of Medicine, and colleagues invited women to participate in a survey designed to assess how the diagnosis had been communicated to them. The survey also asked respondents to provide details about their diagnosis, their support system during treatment and their demographic information.
Results showed approximately 70% of breast cancer diagnoses made from 1967 through 2000 were communicated to patients in person.
However, the percentage of in-person diagnoses decreased over time. About two-thirds of survey respondents diagnosed with breast cancer from 2013 to 2017 received their diagnosis by phone.
Survey respondents who identified themselves as heterosexual, reported having support members and received a diagnosis of in situ breast cancer appeared more likely to receive notification by phone.
HemOnc Today spoke with McElroy about the study, the potential explanations for the change in diagnosis communication, and the implications of the results.
Question: How did this study come about, and how did you conduct it?
Answer: It was kind of an opportunistic analysis. We were looking at the Dr. Susan Love Research Foundation’s Army of Women. This is a voluntary registry of women who are interested in breast cancer research, some of whom have never had breast cancer. To prepare for potential grant applications, we wanted to find out how many sexual minority women were part of that group. The Army of Women sent a survey out through a one-time email blast. We received about 6,000 responses, nearly half (n = 2,896) of whom had received a breast cancer diagnosis. One of the questions asked those who had breast cancer how they heard about their diagnosis. We were not expecting to see the number of women receiving breast cancer diagnoses over the phone increase to 60% after 2015, up from 25% prior to 2007.
Q: What do you think caused this increase?
A: I’m speculating, but I think it is because we’re in what’s known as the digital age. There is an expectation to hear information more quickly. We have portals, where physicians’ notes about examinations are posted and available for patients. The Health Information Technology for Economic and Clinical Health Act allows for results to be released without clinicians being gatekeepers. It’s all about rapid dissemination of medical results. Physicians see the results 24 hours before the patient. That is the sweet spot for them to be able to have a connection with the patient, particularly if it’s bad news. You can’t call them and say, ‘Come in, see me this moment.’ People are busy. They’re left with making the telephone calls if they want to have that connection with their patients.
Q: What should physicians consider before they deliver bad news over the phone?
A: Delivering bad news is all about patient preferences. There have been a few other qualitative studies that asked patients about their preferences for receiving bad news, and results have been mixed. Some people are very keen on getting the news as soon as possible and then having an appointment to discuss next steps. Some people want to hear it in person. It’s really a matter of having the physician check with the patient and establishing some protocol to figure this out ahead of time. If the patient goes down a path toward a diagnosis, the physician should have a conversation to ask questions about how they would like this information communicated.
Q: University of Missouri has used these study results to modify training for medical students. What has changed?
A: We have added a new component to our standard protocol through which we teach medical students how to deliver bad news by phone. It can be hard to convey empathy for the patient this way, so how do you go about doing that as best you can? There are a few easy things a physician can do before they launch into talking about the test results. For example, the last thing anyone wants to do is break bad news while someone is driving. The first thing a provider has to do when calling a patient is make sure he or she is in a safe spot. It also is important to make sure they are in a private space. If someone picks up their phone in the middle of a meeting or in the middle of the grocery store, they would hear the news in a public setting. Physicians also need to ask if the patient has time. Sometimes people pick up the phone as they are running out the door, and they may not have the time to process the news at that moment.
Q: What is the next step for research?
A: The next step is to find out what patient preferences are. We know that almost 60 percent of women are receiving breast cancer diagnoses over the phone. Is that what they prefer, or is this happening because of circumstances even though it’s not how they would like it to happen?
Q: Does this approach complement the increasing focus on patient-centered care?
A: It definitely goes hand-in-hand with patient-centered care because it is being driven by patients. Many protocols are based on expert opinion, not patient opinion. We traditionally followed what physicians or experts in the field felt was the best way to deliver bad news. One of our recommendations is to start asking patients how they want the news delivered.
Q: Your study showed 40% of patients who received a breast cancer diagnosis in person were alone. What should physicians think about when delivering bad news to someone who does not have a support person with them ?
A: Again, it really is up to the patient. I saw a blog post not long ago in which someone said they’d prefer to have their results emailed because they would be home and could process the information. They then could come in to the physician’s office to discuss the next steps. Some people get annoyed when the physician insists that they come in to hear the news in person. It’s a complicated process for each individual. We tend to think the best situation is to have this news delivered in person, and for someone to be with the patient to offer support. For some people, that’s just not how they work. That is why it is so important to take this research to the next step and gain an understanding of these preferences. – by Joe Gramigna
Reference:
McElroy JA, et al. Support Care Cancer. 2018;doi:10.1007/s00520-018-4383-y.
For more information:
Jane A. McElroy, PhD, can be reached at mcelroyja@missouri.edu.