Effective physician-patient communication could lead to better outcomes for cancer survivors

Ashish Rai

Better communication with health care providers could translate to better outcomes for cancer survivors, according to study findings published in Journal of the National Comprehensive Cancer Network.

“Our study suggests that when cancer care providers are more effective communicators, their patients are more likely to follow medical advice and medication protocols,” Ashish Rai, MBBS, MSPH, PhD, researcher in the department of Surveillance and Health Services Research at American Cancer Society, said in a press release. “Cancer survivors are distinct from many other patients in terms of their provider communication-related needs and expectations.”

Cancer survivors often are older and have comorbidities, and they may feel anxiety about their diagnosis, prognosis, treatment costs or risk for recurrence.

“All of these factors and more can make cancer survivors particularly sensitive in their perception of good care or communication,” Rai said.

Rai and colleagues pooled data on 4,588 cancer survivors included in the Medical Expenditure Panel Survey between 2008 and 2014. Researchers characterized participants as nonelderly, defined as aged 18 to 64 years (n=2,257; median age, 54 years) or elderly, defined as aged 65 years or older (n=2,331; median age, 75 years).

In both groups, cancer survivors with better baseline health reported greater satisfaction with provider communication, whereas patients with more comorbidities at baseline were less satisfied.

“Communication needs vary from patient to patient,” Rai said in the release. “[Although] time constraints do pose a challenge, the amount of time spent is only one of the attributes of effective communication. By tailoring their communication strategy to a patient’s specific needs, providers may be able to communicate more effectively in the same amount of time.”

HemOnc Today spoke with Rai about the study and potential implications of the findings.

Question: How did this study come about?

Answer: We were looking into the patient experience — specifically, the determinants and outcomes of a better patient experience. Patient satisfaction with provider communication is well recognized as a means of measuring patient experience. However, I found that the research was quite sparse in determinants of satisfaction with provider communication among cancer survivors and, more so, the outcomes of patient satisfaction with provider communication, including mental and physical health, and service use.

Q: How did you conduct the study?

A: We used the Medical Expenditure Panel Survey (MEPS) to identify respondents diagnosed with cancer. The MEPS contains information from the provider component of the Consumer Assessment of Health Plans Survey (CAHPS), in which respondents ranked provider communication on a four-point scale ranging from ‘never’ to ‘always’ to track whether their providers listened carefully, explained things in a way that was easy to understand, showed respect for what they had to say, and spent enough time with them. These CAHPS scores and a global 0-10 satisfaction rating were combined to create a composite satisfaction score. Three categories of outcomes in the year following the satisfaction survey were evaluated: health status, health care utilization and health care expenditures. We then used logistic regression to examine the associations between satisfaction scores, survivor characteristics and outcomes.

Q: What did you find?

A: We found that the healthier cancer survivors — as measured by the comorbidities they had and the amount of health care services they used in the year of the survey — reported better satisfaction with provider communication. Elderly survivors with higher satisfaction ratings had better mental health and general health on follow-up. Interestingly, down the road, greater satisfaction with provider communication was associated with less health care service use among younger survivors and lower total health care expenditures among elderly survivors.

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Q: How important is physician-patient communication?

A: We are in an era in which satisfaction with provider communication is also a driver of provider compensation. But, there is a concern that it may foster a movement away from evidence-based medicine and toward customer-service driven medicine, thereby leading to more care but not necessarily better care. The concern is genuine and backed by evidence, but we thought that it may not apply similarly to all patient groups. Cancer survivors, for instance, constitute a very distinct patient group as they more often have greater communication needs in relation to cancer, treatment and treatment-related morbidities. Effective provider communication can streamline cancer survivorship care, alleviate anxiety, and enhance self-care efficacy and treatment adherence.

Q: What are some of the barriers to effective communication between physicians and patients?

A: Barriers include constraints on physicians’ time, intricacy of treatments, and lack of medical literacy among patients. These may be amplified in interactions with complex patients, which cancer survivors more likely are. We did not address the barriers to effective communication in our study. These are solely my opinion.

Q: Can you offer advice for clinicians to help them effectively communicate with their patients?

A: Our results suggest that greater attention needs to be paid to the communication needs of cancer survivors with more comorbid illnesses. Comorbidities are far more common among cancer survivors than the general population. It is essential for cancer care providers to develop skills required to manage complex survivors. Lack of time for provider-patient communication is a common concern, but providers may mitigate the need for more time by tailoring their communication strategy to a survivor’s specific needs.

Q: Is there anything else that you would like to mention?

A: A clear theme that emerged from our findings is that improving cancer survivors’ satisfaction with provider communication would lead to better health outcomes in an efficient manner. Additional research is needed to better define satisfaction with communication and understand the mechanisms of the relationship between satisfaction and health outcomes. – by Jennifer Southall

Reference:

Rai A, et al. J Natl Compr Canc Netw. 2018;doi:10.6004/jnccn.2018.7034.

For more information:

Ashish Rai, MBBS, MSPH, PhD, can be reached at American Cancer Society Inc., 30 Speen St., Framingham, MA 01701; email: ashish.rai@cancer.org.

Disclosure: Rai reports no relevant financial disclosures.