Patient-Driven Second Opinions in Oncology: A Systematic Review

Hillen, Marij A.; Medendorp, Niki M.; Daams, Joost G.; Smets, Ellen M. A.

doi:10.1634/theoncologist.2016-0429

Cited by 105 publications

(123 citation statements)

References 48 publications

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“…Several studies suggest that about 68% of patients seek a second opinion, so that would get another diagnosis or prognosis, and 65% would assurance regarding the diagnosis or treatment options [44,47,[65][66][67]. Furthermore, the patients might seek another opinion to discuss their diagnosis and/or treatment, especially when they are dissatisfied with the first physician [45,47,63,65,68].…”

Section: Resultsmentioning

confidence: 99%

The “Second Opinion Medical Network”

Palmieri¹

2017

Int J Pathol Clin Res

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The "Second Opinion Medical Network" is a consultation referral web and medical office system recruiting a wide panel of real-time available specialists, to whom any patient affected by any disease or syndrome and not satisfied with the diagnosis or therapy can apply for an individual clinical audit. Due to the physician-patient communication gap, most of the patients usually wander around the medical websites looking for proper answers to their health problems. However, this search often becomes compulsive and obsessive and frequently ambiguous and frustrating. Palmieri, et al. defines this borderline or even pathological behavior as the "Web Babel Syndrome"-psychological imbalance affecting young and elderly patients, often with multiple synchronous diseases receiving by their care givers heterogeneous and misleading informations or advices, as well as, confused, contradictory statements and prescriptions. To deal with this problem, the "Second Opinion Medical Network" aims to be a useful "problem-solving" support revisiting each conflictual diagnostic and therapeutic step and properly re-addressing tailored treatments and prognoses, preventing unnecessary investigations and unhelpful and expensive medical and surgical interventions.The aim of this editorial is to describe the role and benefits of such a medical network in our web connected health care system. KeywordsSecond opinion, Network, Surgery, Cancer, EconomyIn 2002, a survey of 4,530 people in Europe and USA showed that 32% of Europeans and 43% of Americans preferred to use health web sites, sponsored by BBC and Yahoo, for health information [3]. However, the internet sites are often lacking of adequate information concerning disease complications and aftercare [4]. This web-searching behaviour is often continuous, compulsory, somehow obsessive, leading to the "Web Babel Syndrome", defined as a physician-patient communication gap frequently occurring when the patient affected by multiple synchronous pathologies, feeds back heterogeneous and misleading informations and prescriptions with the risk to drop in a confusionary state [5][6][7][8].In 1999, the Institute of Medicine report cited fatal medical errors in some 40,000-98,000 Americans PER year [8] supporting once more the concept that a further consultation or specialistic second opinion may be useful antidote to lethal misdiagnosis [9].The term "second opinion" has been widely reported also in histology [10,11] and pathology (e.g. thyroid pathology) [12][13][14][15][16][17][18][19][20] where the diagnosis is often difficult, misunderstood and strongly based on the healthcare professionals' experience. It has been defined as a qualified, interdisciplinary medical opinion, based on medical evidence, of an experienced medical specialist or a team [21]. An effective and helpful second opinion strategy in various pathologies (e.g. oral pathology) is the use of smartphones and software applications, such as WhatsApp Messenger, a crossplatform mobile messaging application that allows the exchang...

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Section: Resultsmentioning

confidence: 99%

The “Second Opinion Medical Network”

Palmieri¹

2017

Int J Pathol Clin Res

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“…A review by Ruetters et al [6] highlighted additional potential reasons: The uncertainty over the purpose of an SO, the confidence and faith in their primary treating physician, the desire not to delay the start of therapy, concerns about too much information, and the fear over an extended period of uncertainty. In a recent review by Hillen et al [2] these same reasons were also mentioned.…”

Section: Introductionmentioning

confidence: 84%

“…An SO is the assessment of a diagnosis or treatment proposal by a second, independent physician within the same specialty as the physician who gave the first opinion. It can be solicited by a patient, physician, or payer [2]. …”

Section: Introductionmentioning

confidence: 99%

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Why Do Cancer Patients Have Difficulties Evaluating the Need for a Second Opinion and What Is Needed to Lower the Barrier? A Qualitative Study

Peier-Ruser

Greyerz

2018

Oncol Res Treat

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Background: Requesting a second opinion (SO) is common in oncology. The reasons and barriers for patients not seeking an SO have yet been to be investigated. Why do patients have difficulties evaluating their need for an SO and what could be done to minimize these barriers? Patients and Methods: A 2-stage qualitative study was conducted. 1) Participants were studied in 3 focus groups (FGs). The participants themselves analyzed and then grouped their statements into defined categories. 2) Results of the FGs were discussed with 7 experts from different professional backgrounds. The interviews were unstructured and detailed in the protocol. The statements underwent thematic analysis. Results: The following 4 main barriers were identified: 1) state of shock, 2) pressure of time, 3) sense of excessive demands and uncertainty triggered by information overload, 4) fear of jeopardizing the patient-physician relationship. The following 4 main suggestions for minimizing the barriers were identified: 1) written patient information, 2) improvement of communication, 3) patient empowerment (PE), 4) holistic approach. Conclusion: These barriers incapacitate the patients from evaluating the need for an SO. To minimize the barriers, PE, self-management support and shared decision making is recommended. While the implementation of these concepts advances, patients can be empowered by psycho-oncological assistance.

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“…Most patients with cancer seeking a second opinion at crucial junctures in care report that the process is helpful and reassuring, regardless of whether such consultations yield a divergent diagnosis or alternative therapies. 7,8 Within established parameters of best practice, nuanced recommendations are expected and encouraged in the pursuit of personalized, patient-centered care, and informed decision making is supported by the clinician community. As an example, the American Cancer Society provides detailed patient resources on this topic and encourages patients to solicit a variety of perspectives to inform their decision making.…”

Section: Physician Practice Variation As a Force In Decision Makingmentioning

confidence: 99%