Reducing uncertainty: motivations and consequences of seeking a second opinion in oncology

Abstract

Background: Cancer patients increasingly seek second opinion (SO) consultations, but there is scarce empirical evidence to substantiate medical and psychological benefits for patients. This is the first study to examine patient-and oncologist-reported (1) motivations and expectations of patients to seek a SO, (2) the perceived medical outcome, and (3) psychological consequences of SOs over time (i.e. patients' uncertainty and anxiety). Material and methods: This multi-informant longitudinal cohort study (SO-COM) included consecutive cancer patients referred for a SO (N ¼ 70; age 28-85), as well as their referring and consulting oncologists. Outcome measures were completed at three time points: Patients and referring oncologists reported motivations and expectations before the SO (T 0 ), patients and consulting oncologists reported the medical outcome of the SO (i.e. discrepancy between first and second opinion) immediately following the SO (T 1 ), and patients reported their uncertainty and anxiety at T 0 , T 1 , and two months following the SO (T 2 ). Results: Cancer patients most frequently reported wanting expert advice, exhausting all options, and/or needing more information as motivations for SOs. Referring oncologists rather accurately anticipated these motivations, except most did not recognize patients' information needs. The vast majority of patients (90.0%) received a medical advice similar to the first opinion, although 65.7% had expected to receive a different opinion. Patients' uncertainty (F ¼ 6.82, p¼.002; g 2 ¼.22), but not anxiety (F ¼ 3.074, p¼.055, g 2 ¼.11) was significantly reduced after the SO. Conclusions: SOs can yield psychological benefits by reducing patients' uncertainty, but the added medical value remains debatable. Referring oncologists may not be fully aware of their patients' information needs. Patients should be better informed about goals and benefits of SOs to better manage their expectations. More cost-effective ways of optimally providing medically and psychologically valuable SOs need to be explored.

Communication about Prognosis during Patient-Initiated Second Opinion Consultations in Advanced Cancer Care: An Observational Qualitative Analysis

“…The presented qualitative analysis was part of a larger prospective mixed-methods study about patient-initiated SOs in medical oncology (SO-COM), which examined communication during SOs and their psychological impact on patients [ 31 ]. The SO-COM study included audio recordings of SO consultations and self-report surveys from patients, referring oncologists and consulting oncologists (for more detailed information, see Lehmann et al [ 31 ]). For the current analysis, we used the audio recordings of the SO-COM study to assess prognostic discussions by advanced cancer patients and consulting oncologists.…”

“…The obstacles of communicating prognosis to advanced cancer patients could be even higher for oncologists conducting second opinions (SO). SOs are medical re-assessments by an independent (i.e., consulting) physician from the same specialty as the treating (i.e., referring) physician [ 2 , 6 , 31 , 32 , 33 ]. In SO consultations, oncologists’ prognostication might be compromised by yet unknown data on success and survival for the opted experimental treatment modalities.…”

“…Previous literature shows that most consulting oncologists refrain from disclosing minor medical discrepancies to avoid disagreeing with the first opinion and confronting patients with inconsistent information [ 35 , 37 , 38 ]. Contradictions could cause uncertainty, confusion, and distress among patients or diminish their trust in the referring oncologist [ 2 , 3 , 31 , 35 ]. The risk of conveying inconsistent information might be increased when discussing prognosis, as its uncertain nature and oncologists’ ambiguous language leave room for interpretation.…”

Oncologists' Communication About Uncertain Information in Second Opinion Consultations: A Focused Qualitative Analysis

“…We present a secondary analysis of data collected in a prospective longitudinal study on communication during SO consultations, the SO-COM study (Lehmann et al, 2020). Data were collected between 2018 and 2019 and the larger study included self-report and observed behavioral data coding of audio-recorded SO consultations.…”

“…Eligible participants for the SO-COM study were adult cancer patients with any type of solid tumor, and who were proficient in the Dutch language (Lehmann et al, 2020). A total of N = 69 SOs were audio-recorded and for the current qualitative analysis, a purposive selection of audio-recorded consultations was used.…”