Lower Patient Ratings of Physician Communication Are Associated With Unmet Need for Symptom Management in Patients With Lung and Colorectal Cancer

Abstract

BACKGROUND AND QUESTION ASKED:In this study, we assessed the prevalence of patientreported unmet needs for management of common cancer symptoms (pain, fatigue, depression, nausea/vomiting, cough, dyspnea, diarrhea) in a population-based sample of patients newly diagnosed with lung and colorectal cancer. How are unmet needs for symptom management in patients with lung and colorectal cancer associated with patient-rated physician communication quality?SUMMARY ANSWER: Fifteen percent of patients newly diagnosed with lung and colorectal cancer reported unmet needs for symptom management. Patients who rated their physician's communication lower had adjusted rates of an unmet need for symptom management that were more than twice as high as patients who rated their physicians with a perfect communication score.WHAT WE DID: Using the diverse nationally representative Cancer Care Outcomes Research and Surveillance cohort of patients with lung and colorectal cancer, we evaluated surveys completed approximately 5 months following diagnosis (N = 5,422) to describe the prevalence of unmet need for symptom management and to study the association of the quality of patient-rated physician communication with unmet need for symptom management using logistic regression with random effects to account for clustering within study sites.WHAT WE FOUND: Overall, 15% (791 of 5,422) of patients reported at least one unmet need for symptom management. Patients who rated their physician's communication score below 80 (on a 0-100 scale) had adjusted rates of unmet need(s) for symptom management that were more than twice as high as patients who rated their physicians with a perfect communication score (23.1% v 10.0%, P , .001). BIAS, CONFOUNDING FACTORS, DRAWBACKS:Patients reported unmet needs for symptom management, but were not asked to describe what these unmet needs were. These unmet needs may relate to lack of clinician attention to assessment and treatment of symptoms; however, they could also represent symptoms that proved refractory to available treatments, which would suggest the need for development of novel therapies for symptom management. Another limitation is that this is a cross-sectional study, and we cannot be certain of the direction of the association between ratings of communication and unmet need. REAL-LIFE IMPLICATIONS:Although patients with lung and colorectal cancer reported a high prevalence of cancer-related symptoms, rates of unmet needs for symptom management were relatively low. Nevertheless, 15% of our population reported at least one unmet need for symptom management during a 4-week period, reminding us that there is room for improvement in the management of symptoms for patients with cancer.The quality of physician communication as rated by patients was strongly associated with unmet need for symptom management. Patients who rated their physician's communication most highly had adjusted rates of unmet needs for symptom management that were less than half those with the lowest ratings. Although our findings do n...

A systematic review of the supportive care needs of people living with and beyond cancer of the colon and/or rectum

“…Help with fatigue/lack of energy (23-32%) (Anderson et al, 2013;Browne et al, 2011;Northouse et al, 1999;Taylor et al, 2012;Walling et al, 2016) post-op (12-27%) (Carlsson et al, 2010;Harrison et al, 2011;Macvean et al, 2007;Santin et al, 2015) 70%; 44%-90% 67%; 46%-73%…”

“…More information about the risk of recurrence (46-63%) (Beckjord et al, 2008;Boudioni et al, 2001;Papagrigoriadis and Heyman, 2003;Salz et al, 2014;Sanoff et al, 2010) and/or symptoms of disease recurrence (89%) (Beckjord et al, 2008;Knowles et al, 1999;Lithner et al, 2015) 81%; 64%-95% 85%; 65%-95% 9 Information/education More information about the short-term and long-term effects of treatment on quality of life (40-78%) (Boudioni et al, 2001;Galloway and Graydon, 1996;Harrison et al, 2011;Kidd, 2014;Knowles et al, 1999;Morrison et al, 2012;Rozmovits et al, 2004;Sanoff et al, 2010) 83%; 73%-90% Health system/patientclinician communication On-going communication/contact with and support from a trustworthy clinician (16-56%) (Jefford et al, 2011;Lam et al, 2016;Li et al, 2012;Lithner et al, 2015Lithner et al, , 2012Rozmovits et al, 2004;Santin et al, 2015;Shun et al, 2014) 86%; 61%-95% Physical/cognitive Help with pain (abdominal) (23-28%) (Anderson et al, 2013;Browne et al, 2011;Di Fabio et al, 2008;Northouse et al, 1999;Taylor et al, 2012;Walling et al, 2016) post-op associated with adhesions/infected wounds/non-healing wounds (Browne et al, 2011;Carlsson et al, 2010;Harrison et al, 2011) 70%; 44%-90% 73%; 73%-90% Information/education More information about the exact diagnosis and what it means (52-80%) (Andersson et al, 2010;Baravelli et al, 2009;Boudioni et al, 2001;…”

“…Table S1. Electronic databases searched and search terms used Help with symptom control (6-62%) (Hansen et al, 2013;Holm et al, 2012;Jorgensen et al, 2012;Lam et al, 2016;Northouse et al, 1999;Russell et al, 2015;Walling et al, 2016) especially:…”

Understanding racial/ethnic differences in breast cancer-related physical well-being: the role of patient–provider interactions

“…For instance, a recent study found that patient-rated physician communication quality was positively associated with patient-rated symptom management quality, with patients rating their physician’s communication highly being more likely to report having their symptom management needs met, compared to those with lower communication scores. 6 Prior studies have also shown that patient-provider interactions differ based on race/ethnicity. Specifically, racial/ethnic minority patients, particularly Asian and black patients, tend to report suboptimal communication with providers, and more discrimination by providers.…”

The Relationship of Patient–Provider Communication on Quality of Life among African-American and White Cancer Survivors

“…Improvements in patient health outcomes have also been reported including improved symptom resolution, physical functioning, physiological status (e.g., blood pressure, HbA1c) and pain (Stewart, 1995). Studies specifically focused on cancer patients have shown similar impact on patient’s treatment participation (Street & Voigt, 1997), self-management behaviors (Walling et al, 2016) and physical and emotional health outcomes (Lake et al, 2014). Despite the importance of patient-provider communication, cancer patients’ communication needs often go unmet (Bruinessen et al, 2013).…”