Information, communication, and cancer patients’ trust in the physician: what challenges do we have to face in an era of precision cancer medicine?

Abstract

Purpose Despite promising achievements in precision cancer medicine (PCM), participating patients are still faced with manifold uncertainties, especially regarding a potential treatment benefit of molecular diagnostics (MD). Hence, MD poses considerable challenges for patient information and communication. To meet these challenges, healthcare professionals need to gain deeper insight into patients’ subjective experiences. Therefore, this qualitative study examined information aspects of MD programs in cancer patients. Methods In two German Comprehensive Cancer Centers, 30 cancer patients undergoing MD participated in semi-structured interviews on information transfer and information needs regarding MD. Additionally, patients provided sociodemographic and medical data and indicated their subjective level of information (visual analogue scale, VAS, 0–10). Results On average patients had high levels of information (mean = 7, median = 8); nevertheless 20% (n = 6) showed an information level below 5 points. Qualitative analysis revealed that patients show limited understanding of the complex background of MD and have uncertainties regarding their personal benefit. Further, patients described unmet information needs. Existential threat in awaiting the results was experienced as burdensome. To withstand the strains of their situation, patients emphasized the importance of trusting their physician. Conclusion The challenges in PCM consist in providing unambiguous information, especially concerning treatment benefit, and providing guidance and support. Therefore, psycho-oncology needs to develop guidelines for adequate patient communication in order to help healthcare providers and cancer patients to handle these challenges in the developing field of PCM.

Parents’ and adolescents’ perspectives and understanding of information about childhood cancer precision medicine

“…Precision medicine–related concepts are challenging to understand, particularly amid uncertainty about whether a patient will benefit from participating and with that use of novel molecular profiling techniques 17,25–27 . Our findings illustrated the complexity of informing families about precision medicine for high‐risk childhood cancer.…”

Understanding communication between patients and healthcare professionals regarding comprehensive biomarker testing in precision oncology: A scoping review

“…20,33,36 Patients need guidance throughout the cBT process and associated treatment as well as information tailored to their individual situation. 12,15,16,33,35 Careful management of relevant information and trust in their physician can help the patients feel informed rather than overwhelmed, so HCPs should choose an appropriate manner (e.g., language, illustration, and emotional support) and amount of information to be delivered, also pre-testing. 16,37,45 To tailor information according to individual preferences, informed consent processes might be, for example, organized using a "tiered and binned model of counseling," as previously developed for the purpose of multiplex testing for cancer susceptibility.…”

“…The Netherlands 4 (9.5) 17,26,40,51 France 3 (7.1) 11, 41,44 Other (Belgium, Germany) 3 (7.1) 7,12,39 EMR Saudi Arabia 1 (2.4) 62 Study design Qualitative 10 (23.8) 12,17,[19][20][21]26,[36][37][38]53 Quantitative 7 (16.7) 18,27,28,43,50,51,80 Combined-qualitative and quantitative a 8 (19.0) [29][30][31][32][33][47][48][49] Other b 17 (40.5) 7,11,22,34,35,[39][40][41][42][44][45][46]52,54,55,61,…”

“…7,11 Further, this complexity challenges both the healthcare professionals' (HCPs) and patients' understanding of precision oncology aspects (e.g., individual benefit of cBT and the targeted treatment for the patient). 7,11,12 Steady progress and remarkable achievements have been made with respect to cBT-informed treatments 8,13 ; however, a therapeutic benefit of such treatments is still not always guaranteed. 8,14 This is often in strong contrast to the high expectations of patients and their families, 15,16 which could be elevated by a lack of knowledge that potentially also influences their decision-making toward cBT.…”

Com‐On Questionnaire: Development and validation of a questionnaire for evaluating communication skills of oncologists

“…The third subscale ‘empathy’ reflects if the physician is capable of showing interest in the patient's feelings and if they react in an appropriate and supporting way. A trustful relationship and a supporting atmosphere were shown to be important factors in patient's perception of the physician's commitment (Pichler et al, 2021). Furthermore, cancer patients wish for validation and empathic support in order to be able to cope with the existential threat and probable stigmatisation caused by their illness (Arora, 2003).…”