Communication strategies can help clinicians address cancer-related misinformation
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Given the proliferation of consumer-facing health information online, clinicians often find themselves addressing potentially harmful cancer misinformation with their patients.
As trusted sources of information, clinicians are in a unique position to clarify this misinformation and educate patients on where to find legitimate cancer resources.
To better understand the conversations clinicians have with patients about cancer misinformation, researchers Carma L. Bylund, PhD, professor in the department of health outcomes and biomedical informatics at University of Florida College of Medicine, and Skyler B. Johnson, MD, assistant professor in the department of radiation oncology at University of Utah Huntsman Cancer Institute, conducted a thematic analysis of how clinicians address misinformation with cancer patients during clinical visits.
“Many years ago, there was a very paternalistic model in medicine, where patients came into the clinic, the doctor said, ‘This is what you’re going to do,’ the patient said, ‘OK,’ and that was it,” Johnson told Healio. “This study highlights a different era of communication — many of these providers describe really engaging with patients to help them make the best decisions for them, whatever they may be. I found that very encouraging.”
Bylund and Johnson spoke with Healio about the themes their study identified and potential next steps in their research on cancer misinformation.
Healio: What prompted you to conduct this study?
Bylund: Over the last few years, I’ve thought about the increased interest in online cancer information — this has been an area of increased focus for the NCI. I decided to focus my research more on misinformation, and that’s when I sought out Skyler. He was one of the only people writing about misinformation in a cancer treatment setting. This paper is a very natural overlap between our two areas of research.
Johnson: We are working in these different spaces, and I was studying outcomes in patients with cancer who sought out therapies that could qualify as being related to misinformation. I was looking at how that impacted their survival. In my conversations with other researchers and physicians, they would often ask, “How can we mitigate the impact of cancer misinformation?” This is why it’s been so great to work with Carma — she is a communication expert when it comes to physicians and patients.
Healio: Can you describe the methodology of your study?
Bylund: We conducted semi-structured interviews with 21 cancer clinicians, including. 19 physicians, a physician assistant and a nurse practitioner. We identified four themes that characterize how clinicians address misinformation with patients.
Johnson: The methodology of this study is important because it answers questions about how clinicians talk with patients about misinformation in a real-world cancer clinical setting. It’s an important first step to improving these conversations.
Healio: What did you find about the themes of these conversations?
Bylund: Through our qualitative analysis, we found certain themes came up repeatedly. We heard that clinicians would try to understand the misinformation that was being discussed. This is a very good, patient-centered strategy — the idea of understanding something before you try to educate the patient about it. They were not just discounting the information immediately, but asking open questions, taking an inquisitive approach.
Correcting the misinformation was another strategy and another theme we identified. There was some variation in the way clinicians did this, but obviously this is key.
The theme I found most interesting is advising about future online searches. To me, that indicates the clinician is being proactive; they’re trying to help the patient avoid making the same mistake. So, they advise them where to find reputable information online. We don’t have data to support this yet, but I think it would be great for clinicians to advise patients in this way before patients ever go online. It would be like giving them an information prescription of sorts.
The last strategy we identified was preserving the clinician-patient relationship. This is really the foundation — it’s present in all the other strategies. We know from the literature how that relationship and that communication is essential to good outcomes.
Healio: Did your study determine which of these approaches works best, or exactly what clinicians should say?
Johnson: That is a bit harder to answer, because we didn’t test whether a certain methodology is more effective than others. It was interesting to read about how providers gave varying advice to patients about going online. It was similar to some of our other work where we developed a ‘stoplight’ typology, with some clinicians advising patients to avoid going online altogether and others advising that they exercise caution when searching online. That is more of a yellow light kind of approach. Other clinicians encouraged patients to go online, emphasizing that it is important to advocate for themselves. Even more important, there is the green light strategy, where the clinician not only encourages the patient to go online, but suggests some good resources. So, it’s a sort of spectrum.
Interestingly, Carma and I just submitted a grant proposal to study the best approaches to communication about cancer treatment misinformation. So, we’re looking forward to answering this question with evidence-based data.
Bylund: We have to keep in mind that these are clinicians who agreed to talk to us for 45 minutes or an hour about communication, so that tells you something right there. They already think communication is important. Additionally, they are telling us the approaches that have been effective. One of our reviewers brought that up — these conversations probably represent physicians on their best days. As Skyler said, we weren’t trying to identify the best approach in this study — this was more descriptive, and a first step for us to go and do further work on this.
Johnson: Because I split time between doing this research and also seeing patients, I’m aware of many barriers to being able to have these kinds of quality conversations with patients. In a real-life clinical setting, there isn’t a lot of time to sit down and talk with patients about online misinformation after already talking to them for 30 to 45 minutes about their diagnosis, treatment and prognosis. Often, I need to go and see the next patient, and it’s just really difficult to sit back down and talk about online misinformation. So, there really are external barriers, as well.
Bylund: Misinformation really is a multifaceted problem that needs to be addressed from many different angles. It’s not just about helping clinicians to talk about it better — it’s also about how we can help patients identify better information in the first place so maybe these conversations don’t necessarily have to take place. Maybe they can be done with artificial intelligence and other technologies to flag some of this information. I think there are a lot of ways for us to approach combating this issue.
For more information:
Carma L. Bylund, PhD, can be reached at University of Florida Health Cancer Center, Weimer Hall 2022, 2004 Mowry Road, Gainesville, FL 32610; email: carma.bylund@ufl.edu.
Skyler B. Johnson, MD, can be reached at Huntsman Cancer Institute, 1950 Circle of Hope, Salt Lake City, UT 84112; email: skyler.johnson@hci.utah.edu.
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