Gaps in patient-physician communication at the time of malignant bowel obstruction from recurrent gynecologic cancer: a qualitative study.

Abstract

Purpose We sought to investigate the patient and physician approaches to malignant bowel obstruction (MBO) due to recurrent gynecologic cancer by 1) comparing patient and physician expectations and priorities during a new MBO diagnosis, and 2) highlighting factors that facilitate patient-doctor communication.Methods Patients were interviewed about their experience during an admission for MBO, and physicians were interviewed about their general approach towards MBO. Interviews were analyzed for themes using QDAMiner qualitative analysis software. The analysis utilized the framework analysis and used both predetermined themes and those that emerged from the data.Results We interviewed 14 patients admitted with MBO from recurrent gynecologic cancer and 15 gynecologic oncologists. We found differences between patients and physicians regarding plans for next chemotherapy treatments, foremost priorities, communication styles, and end-of-life discussions. Both patients and physicians felt that the patient-physician communication was improved in situations of trust, understanding patient preferences, corroboration of information, and increased time spent with patients during and before the MBO.Conclusion Gaps in patient-physician communication could be targeted to improve the patient experience and physician counseling during a difficulty diagnosis by focusing on education, symptoms, home support, nutrition, and end-of-life care.

Palliative care is a critical part of gynecologic oncologic care

“…Our study team conducted a qualitative study of women admitted for malignant bowel obstructions from ovarian cancer; we found many gaps in communication and expectations between women and their primary gynecologic oncologist (7). These included discussion of goals such as future chemotherapy (most patients expected more chemotherapy after the diagnosis of a malignant bowel obstruction while most physicians considered it a contraindication), planning for support after discharge (patients were much more likely to discuss a desire to go home), and frustration at the uncertainty associated with the diagnosis (patients desired more concrete information and physicians struggled with prognostic uncertainty) (7). We suggested that a decision aid, such as proposed by Wieringa and colleagues, could assist in presenting the information on the diagnosis, options, risks/benefits and guide to patient preference deliberation (8).…”