The Role of Physician-Patient Communication in Cancer Clinical Trials

Terrance Albrecht, Ph.D.

Professor

Department of Interdisciplinary Oncology

University of South Florida College of Medicine

H. Lee Moffitt Cancer Center & Research Institute

Institute of Medicine ReportEnsuring Quality Cancer Care (1999)

Recommendation #4:

“Improve access to high quality clinical trials”

“Improve policies to ensure full disclosure of information about appropriate treatment options”

Response by NCI: “Begin learning how patients obtain information,identifying their preferences for

information and developing communication ‘products’ to help consumers, cancer patients, survivors and families make better informed treatment decisions”

The Problem Clinical trials are the means for finding the best

treatments and cures for cancer; however: Insufficient numbers of patients on studies Under-representation of minority and elderly

populations Unmet needs of patients, family members/significant

others, and physicians Wide variation in physician communication behavior Negative press reports create resistance from

eligible patients and families

Funding

Preliminary studies supported by the H.Lee Moffitt Cancer Center and Research Institute, #G80502 (1993-2000).

Current grant: “Effects of Physician Communication on Patient Accrual,” RO1 CA75003-01A3, NCI, 4/01/01 – 3/31/04.

Collaborators1

John Ruckdeschel, M.D. Dawn Riddle, Ph.D. Michael Coovert, Ph.D. Louis Penner, Ph.D. Gerald Barbosa, M.D. Benjamin Djulbegovic, M.D., Ph.D. James Helm, M.D., Ph.D. Christina Blanchard, MSSW, Ph.D. Gwendolyn Quinn, Ph.D.

1See selected publications

Reasons Patients Do or Do Not Enroll in Cancer Clinical Trials

DO ENROLL: DO NOT ENROLL: Perceive their needs not

physician’s priority Disrupt quality of life, functional

abilities Anxiety about randomization Worry might not receive best

treatment Concern about logistical difficulties Perceive insurance problems Concern about excessive toxicity Poor understanding of study Family against study participation Worry about excessive burden on

family/friends

Trust in their physician

Physician recommended study

Physician responsive to questions and issues

Encouragement by family

Manageable side effects

Altruism

Desire to live

Current NCI Grant Previously found:

Physician communication--style and content--linked to patients’ treatment decisions choices

Disconnect between what we think occurs and what actually occurs in MD-PT encounters

Still need to demonstrate impact of communication on patient’s treatment decision making--compared to other determinants—What determines patient choice?

Expect the presence of a family member complicates the interaction

Patient

Physician

Communication Treatment Decision

Study Protocol

CommunicationFamilyMember

Model of Patient Decision Making

How to Study the Complex Process of Communication Design/create original digital video

recording, editing suite, and analysis system

Five criteria for recording system: Capture audio and video Portable/economical Unobtrusive Protect human subjects’ confidentiality Provide concrete evidence of specific behaviors

that comprise effective MD-PT communication

Communication for Improving Quality Cancer Care

Train physicians to: Invite/elaborate patient/family member

questions Check patient/family knowledge--offer culturally

and linguistically appropriate explanations Encourage information record Become well versed in types of available

services Provide social support and hope

Current and Future Directions

Investigations to develop communication strategies for: Increasing quality of life and survivorship—(example:

Assisting parents of children undergoing painful procedures) Improving public education about genetic risks Reducing health disparities in cancer care for

minority/underserved patients