Dumping the information bucket: A qualitative study of clinicians caring for patients with early stage non-small cell lung cancer |
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| Affiliation: | 1. Health Services Research & Development, VA Portland Health Care System, Portland, OR, USA;2. Department of Radiation Medicine, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA;3. Radiation Oncology Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA;4. Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, USA;5. Department of Medicine, Oregon Health & Science University, Portland, OR, USA;6. Section of Pulmonary & Critical Care Medicine, VA Portland Health Care System; Portland, OR, USA;1. Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Switzerland;2. Division of Therapeutic Education for Chronic Diseases, Geneva University Hospitals and Director, WHO Collaborating Centre for Reference and Research in the Field of Education and Long-Term Follow-up Strategies for Chronic Diseases, Switzerland;1. School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC, V2Y 1Y1, Canada;2. Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, 588-1081 Burrard Street, St. Paul’s Hospital, Vancouver, BC, V6Z 1Y6, Canada;3. School of Nursing, University of Victoria, P.O. Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada;4. Department of Health Studies, Faculty of Social Sciences, University of Stavanger, 4036 Stavanger, Norway;5. University of Gothenburg Centre for Person-Centred Care, P.O. Box 457, SE-40539 Gothenburg, Sweden;6. Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, P.O. Box 457, SES-49539 Gothenburg, Sweden;7. Department of Colorectal Surgery, Sahlgrenska University Hospital/East, SE_41685 Gothenburg, Sweden;8. Department of Vascular Surgery, Sahlgrenska University Hospital, SE-41345 Gothenburg, Sweden;1. Department of Psychiatry, University of North Carolina, 170 Manning Drive, CB 7305, Chapel Hill, NC 27599, USA;2. Lineberger Comprehensive Cancer Center Biostatistics Core Facility, University of North Carolina, 450 West Drive, Chapel Hill, NC 27514, USA;3. H. W. Odum Institute for Research in Social Science, University of North Carolina at Chapel Hill, 208 N. Raleigh St., CB3355, Chapel Hill, NC 27599, USA;4. School of Medicine, University of North Carolina, 321 S. Columbia St., Chapel Hill, NC 27516, USA;5. Department of Medicine, University of North Carolina, 125 MacNider Hall, CB7005, Chapel Hill NC 27599, USA;1. Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA;2. Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;3. Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA;4. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;5. Department of Community-Public Health, Johns Hopkins School of Nursing, Baltimore, MD, USA;6. Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA;7. Division of Genetics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA;8. Harvard Medical School, Boston, MA, USA;9. Broad Institute of MIT and Harvard, Cambridge, MA, USA;10. Partners Personalized Medicine, Boston, MA, USA;1. Community Health and Health Behavior, University at Buffalo, Buffalo, NY;2. Urologic Oncology, Roswell Park Cancer Institute, Buffalo, NY |
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| Abstract: | ObjectiveTo evaluate the quality of patient-clinician communication and shared decision making (SDM) when two disparate treatments for early stage non-small cell lung cancer (NSCLC) are discussed.MethodsWe conducted a qualitative study to evaluate the experiences of 20 clinicians caring for patients with clinical Stage I NSCLC prior to treatment, focusing on communication practices. We used directed content analysis and a patient-centered communication theoretical model to guide understanding of communication strategies.ResultsAll clinicians expressed the importance of providing information, especially for mitigating patient worry, despite recognition that patients recall only a small amount of the information given. When patients expressed distress, clinicians exhibited empathy but preferred to provide more information in order to address patient concerns. Most clinicians reported practicing SDM, however, they also reported not clearly eliciting patient preferences and values, a key part of SDM.ConclusionCommunication with patients about treatment options for early stage NSCLC primary includes information giving. We found that only a few communication domains associated with SDM occurred regularly, and SDM may not be necessary in this clinical context.Practice implicationsClinicians may need to incorporate nurse navigators or more written materials for effectively discussing potentially equivalent treatment options with their patients. |
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| Keywords: | Thoracic diseases Patient-centered outcomes Communication |
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