Many oncologists dropping the ball at first consult, study says

The first meeting between a patient and a hematology-oncology subspecialist is a crucial event in the cancer patient-cancer doctor relationship, and according to recent findings, many doctors aren't quite living up to their end.

Researchers at the Fred Hutchinson Cancer Research Center and the Dana-Farber Cancer Institute examined the first consultations for 236 patients and 40 physicians in the so-called HEMA-COMM study looking for certain communication behaviors that experts believe ought to be part of the doctor-patient relationship from the get-go.

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These patients came in to see a subspecialist with a range of diagnoses, with the slim majority (31%) having lymphoma. Median duration of the consultation was 80 minutes.

The frequency at which recommended communication behaviors occurred:
Discussion about purpose of the visit (78%)
Patient prior knowledge about disease (89%)
Patient preference for decision-making role (37%)
Patient understanding of presented information (31%)
Patient preference for information (5%)

Perhaps the most troubling figure is how often (23%) doctors hedged the prognosis, meaning that they would suggest that a prognostic estimate didn't apply to the individual. For example, the doctor might say that the patient's statistical prognosis gives them a 20% chance of responding to treatment, then hedge—or subvert—that bad news with something more reassuring, such as "I've had better results with my patients than what is published," or "Of course, let me preface this with you that numbers are meaningless in your situation."

However, most consultations (64%) featured unambiguous discussion of mortality risk without any hedging, and when surveyed afterwords, the overwhelming majority (98%) of patients were pleased with their involvement in decision-making, and four of five said they would recommend the doctor to another patient.

By Ross Bonander

Source: Lee S, et al "Content of hematologic malignancies consultations: Good and bad news from the HEMA-COMM Study" ASH Abstract 68.

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