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Assessment of Approaches to Discussing Alternative Treatment Options in Multidisciplinary Cancer Care.

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Title: Assessment of Approaches to Discussing Alternative Treatment Options in Multidisciplinary Cancer Care.
Authors: Gayed, G.1 (AUTHOR), Contrada, R.1 (AUTHOR), Shteyler, V.2 (AUTHOR), Barchi, F.3 (AUTHOR), Duberstein, P.4 (AUTHOR), Mattes, M.D.5 (AUTHOR)
Source: International Journal of Radiation Oncology, Biology, Physics. 2022 Supplement, Vol. 114 Issue 3, pS154-S155. 2p.
Subjects: Oncology nursing, Patients' attitudes, Cancer treatment, Medical personnel, Wilcoxon signed-rank test, Medical practice
Abstract: Guidelines for improving healthcare delivery and the patient care experience call for physicians to inform patients of all available treatment options with comparable efficacy. In oncology, such information is often not fully provided when curative treatment options (e.g., surgery or radiation) fall outside the scope of practice of the physician(s) who see a patient. We hypothesize that this common practice would be less acceptable than a more balanced, multidisciplinary approach, for individuals who work in a healthcare setting. An electronic survey was sent in July 2021 to a variety of physicians, trainees, nurses, therapists, researchers, and administrators employed at a single NCI-designated cancer center. Participants were asked to imagine being diagnosed with a potentially life-threatening illness that can be treated and cured in two standard ways, with similar efficacy but different side effect profiles and impact on short- and long-term quality-of-life (Procedure A performed by Doctor A, and Procedure B performed by Doctor B). Neither doctor has formal cross-training in the other's procedure. All patients are diagnosed by Doctor A and see him/her first, and only learn about Procedure B from Doctor B if referred by Doctor A. To avoid bias, there was no reference to cancer, surgery, or radiation in the scenario. A Likert-type scale ranging from 1 (completely unacceptable) to 5 (completely acceptable) assessed Doctor A's approach to discussing treatment options in each scenario. Descriptive statistics and Wilcoxon signed-rank tests are reported. 286 individuals responded (response rate 17%), among which 166 (64%) were female, 176 (62%) had an advanced degree, and 66 (26%) were physicians from 17 unique medical specialties. The mean Likert-type score was 1.58 (SD 0.93) for Approach #1 where Doctor A only presents Procedure A; 1.75 (SD 0.98) for Approach #2 where Doctor A presents both options but favors Procedure A; 2.54 (SD 1.35) for Approach #3 where Doctor A presents both options but favors Procedure A despite offering a referral to Doctor B to discuss Procedure B; and 4.75 (SD 0.76) for Approach #4 where Doctor A routinely refers all patients to Doctor B so each treatment option is discussed with the physician who performs each. Each of these differences were statistically significant (p < 0.01). The table below shows the percentage of respondents who believed it very or extremely important that Procedure B be discussed as a reasonable alternative to Procedure A for varying combinations of cure rate and toxicity risk. A balanced, multidisciplinary approach to discussing treatment options is strongly favored by most healthcare professionals. This is consistent with improving quality of healthcare delivery and patients' experience. [ABSTRACT FROM AUTHOR]
Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Guidelines for improving healthcare delivery and the patient care experience call for physicians to inform patients of all available treatment options with comparable efficacy. In oncology, such information is often not fully provided when curative treatment options (e.g., surgery or radiation) fall outside the scope of practice of the physician(s) who see a patient. We hypothesize that this common practice would be less acceptable than a more balanced, multidisciplinary approach, for individuals who work in a healthcare setting. An electronic survey was sent in July 2021 to a variety of physicians, trainees, nurses, therapists, researchers, and administrators employed at a single NCI-designated cancer center. Participants were asked to imagine being diagnosed with a potentially life-threatening illness that can be treated and cured in two standard ways, with similar efficacy but different side effect profiles and impact on short- and long-term quality-of-life (Procedure A performed by Doctor A, and Procedure B performed by Doctor B). Neither doctor has formal cross-training in the other&#39;s procedure. All patients are diagnosed by Doctor A and see him/her first, and only learn about Procedure B from Doctor B if referred by Doctor A. To avoid bias, there was no reference to cancer, surgery, or radiation in the scenario. A Likert-type scale ranging from 1 (completely unacceptable) to 5 (completely acceptable) assessed Doctor A&#39;s approach to discussing treatment options in each scenario. Descriptive statistics and Wilcoxon signed-rank tests are reported. 286 individuals responded (response rate 17%), among which 166 (64%) were female, 176 (62%) had an advanced degree, and 66 (26%) were physicians from 17 unique medical specialties. The mean Likert-type score was 1.58 (SD 0.93) for Approach #1 where Doctor A only presents Procedure A; 1.75 (SD 0.98) for Approach #2 where Doctor A presents both options but favors Procedure A; 2.54 (SD 1.35) for Approach #3 where Doctor A presents both options but favors Procedure A despite offering a referral to Doctor B to discuss Procedure B; and 4.75 (SD 0.76) for Approach #4 where Doctor A routinely refers all patients to Doctor B so each treatment option is discussed with the physician who performs each. Each of these differences were statistically significant (p &lt; 0.01). The table below shows the percentage of respondents who believed it very or extremely important that Procedure B be discussed as a reasonable alternative to Procedure A for varying combinations of cure rate and toxicity risk. A balanced, multidisciplinary approach to discussing treatment options is strongly favored by most healthcare professionals. This is consistent with improving quality of healthcare delivery and patients&#39; experience. [ABSTRACT FROM AUTHOR]
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  Data: &lt;i&gt;Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
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        Value: 10.1016/j.ijrobp.2022.07.637
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