Characterizing patient-oncologist communication in genomic tumor testing: The 21-gene recurrence score as an exemplar |
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| Authors: | Suzanne C O’Neill Susan T Vadaparampil Richard L Street Tanina Foster Moore Claudine Isaacs Hyo S Han Bianca Augusto Jennifer Garcia Katherine Lopez Matilda Brilleman Jinani Jayasekera Susan Eggly |
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| Institution: | 1. Department of Oncology, Georgetown University, Washintgon DC, USA;2. Department of Health Outcomes and Behavior, Moffitt Cancer Center, USA;3. Department of Communication, Texas A&M, USA;4. Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, USA;1. Cancer Experiences Research, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria, 3000, Australia;2. Day Therapies & Radiotherapy, Peter MacCallum Cancer Centre, Melbourne, Australia;3. Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia, Melanoma and Skin Service, Peter MacCallum Cancer Centre, Melbourne, Australia;4. Lung Service, Peter MacCallum Cancer Centre, Melbourne, Australia;5. Lifebuoy, Melbourne, Australia;1. Gold Coast Hospital and Health Service, Gold Coast, Australia;2. Griffith University School of Medicine, Gold Coast, Australia;3. Compassionate Gold Coast, Australia;4. Charter for Compassion, Australian Compassion Council, Australia;5. Deakin University Faculty of Health, School of Medicine, Australia;6. HammondCare, Greenwich Hospital, Sydney, Australia;7. Northern Clinical School University of Sydney, Sydney, Australia;8. Bond University, School of Health Science and Medicine, Australia;1. Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA;2. College of Journalism and Communications, University of Florida, Gainesville, FL, USA;3. College of Medicine, University of Florida, Gainesville, FL, USA;4. Department of Psychology, University of Arizona, Tucson, AZ, USA;5. Weill Cornell Medical College, New York, NY, USA;1. Biomedical Ethics Research Program, Mayo Clinic, Rochester, USA;2. Biomedical Ethics Research Program, Mayo Clinic, Rochester, USA;3. Davidson College, Davidson, USA;4. Biomedical Ethics Research Program, Mayo Clinic, Rochester, USA;5. Biomedical Ethics Research Program, Mayo Clinic, Rochester, USA;6. Geisel School of Medicine, Dartmouth College, Hanover, USA;7. Biomedical Ethics Research Program, Mayo Clinic, Rochester, USA;1. Fourth Military Medical University, School of Nursing, Xi’an, China;2. Fourth Military Medical University, The First Affiliated Hospital, Xi’an, China;1. Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Netherlands;2. Leiden Institute for Brain and Cognition (LIBC), Leiden, Netherlands;3. Oncology Center, Leiden University Medical Center, Leiden, Netherlands;4. Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands |
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| Abstract: | ObjectiveWomen with early-stage, ER + breast cancer are recommend to receive genomic profiling tests, such as the 21-gene Recurrence Score (RS) test, to guide treatment decisions. We examined test- and treatment-related information discussed and the associations between RS categories and aspects of communication during patient-oncologist clinical encounters.MethodsAs part of a larger trial, clinical encounters (N = 46) were audiorecorded and coded for 1) RS- and treatment-related information, 2) shared decision making, 3) patient active participation, and 4) oncologist patient-centered communication. We examined differences by RS category using mixed models, adjusting for nesting within oncologist.ResultsPatients with a high RS were more likely to receive a chemotherapy recommendation (p < .01), hear about the risks/side effects of chemotherapy (p < .01), and offer their preferences (p = .02) than those with intermediate or low RS. Elements of shared decision making increased with RS. Oncologist patient-centered communication (M = 4.09/5, SD = .25) and patient active participation (M = 3.5/4, SD = 1.0) were high across RS.ConclusionFindings suggest that disease severity, rather than clinical uncertainty, impact treatment recommendations and shared decision making.Practice implicationsOncologists adjust test- and treatment-related information and shared decision making by disease severity. This information provides a framework to inform decision making in complex cancer and genomics settings. |
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| Keywords: | Breast cancer 21-gene Communication Patient-clinician communication Shared decision making |
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