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Jdonkey A. McElroy
According to a study conducted by researchers at the University of Missouri, the percentage of breast cancer patients who receive their diagnosis over the phone has increased dramatically over the past decade.
Jdonkey
A.
McElroy, PhD, Professor of Family and Community Medicine at the MU School of Medicine, and her colleagues invited women to participate in a survey to assess how the diagnosis was communicated to them. The survey also asked respondents to provide details about their diagnosis, their support system during treatment and their demographic information.
The results showed that about 70% of breast cancer diagnoses made between 1967 and 2000 had been communicated to patients in person.
However, the percentage of in-person diagnoses decreased over time. About two-thirds of survey respondents who were diagnosed with breast cancer between 2013 and 2017 received it over the phone.
Survey respondents who identified themselves as heterosexuals, reported having support members and were diagnosed with breast cancer in situ seemed more likely to receive a telephone notification.
HemOnc today discussed with McElroy about the study, possible explanations of the change in the communication of diagnoses and the consequences of the results.
Question: How did you
this study comes aboutand how did you drive it?
Reply: It was a kind of opportunistic analysis. We looked at the Women's Army of the Susan Love Research Foundation. There is a voluntary register of women interested in breast cancer research, some of whom have never had breast cancer. To prepare potential grant applications, we wanted to know how many women belonging to a sexual minority were in this group. The Women's Army sent an inquiry by email. We received approximately 6,000 responses, almost half of which (n = 2,896) were diagnosed with breast cancer. One of the questions asked those who had breast cancer how they had heard about their diagnosis. We did not expect the number of women diagnosed with breast cancer on the phone to increase by 60% after 2015 compared to 25% by 2007.
Q: What do you think is the cause of this increase?
A: I speculate, but I think it's because we're in the so-called digital era. We expect to hear information sooner. We have portals where doctors' notes about exams are posted and available to patients. The Health Information Technologies Act for Economic and Clinical Health allows the publication of results without the clinicians being custodians. This is the rapid dissemination of medical results. Doctors see the results 24 hours before the patient. This is the ideal focus for them to have a connection with the patient, especially if it is bad news. You can not call them and say, "Come in, see me this moment." People are busy. They are forced to make phone calls if they want to have this link with their patients.
Q: What should physicians consider before announcing bad news over the phone?
A: Giving bad news is about patient preferences. Some other qualitative studies have questioned patients about their preferences for receiving bad news and the results have been mixed. Some people are keen to receive the news as quickly as possible and then make an appointment to discuss next steps. Some people want to hear it in person. This is really about asking the doctor to check with the patient and establish a protocol to resolve it in advance. If the patient is going for a diagnosis, the doctor should have a conversation to ask him how he wants this information to be communicated.
Q:
University of Missouri
used these study results to modify the training of medical students. What's changed?
A: We have added a new component to our standard protocol by which we teach medical students how to announce bad news over the phone. It can be difficult to convey empathy to the patient, so how do you do it as best you can? A doctor can do a few simple things before embarking on a discussion about the test results. For example, the last thing to do is to announce bad news while driving. The first thing a provider needs to do to call a patient is to make sure he is in a safe place. It is also important to make sure they are in a private area. If someone picks up his phone in the middle of a meeting or at the grocery center, he hears the news in public. Doctors must also ask if the patient has time. Sometimes people pick up the phone as they head for the door and may not have the time to process the information at that time.
Q: What is the next step of the research?
A: The next step is to determine what are the patient's preferences. We know that almost 60% of women are diagnosed with breast cancer by telephone. Is that what they prefer or does it happen because of circumstances even if it's not as they would like it to happen?
Q: Does this approach complement the growing focus on patient-centered care?
A: This certainly goes hand in hand with patient-centered care because it is patient-led. Many protocols are based on expert advice and not on patients. Traditionally, we followed what doctors or experts in the field thought was the best way to announce bad news. One of our recommendations is to start asking patients how they want the news to be delivered.
Q: Your study showed that 40% of
patients diagnosed with breast cancer in person were alone. What should doctors think about when they communicate bad news to someone who does not have support?
nobody with them
?
A: Again, it really depends on the patient. I recently saw a blog post in which someone said he preferred to receive his results by email because he would be at home and could process the information. They could then go to the doctor's office to discuss next steps. Some people get upset when the doctor insists that they hear the news in person. It's a complicated process for every individual. We tend to think that the best situation is that this information is delivered in person and that a person accompanied by the patient is supportive. For some people, that's not how they work. That's why it's so important to continue this research and understand these preferences. – by Joe Gramigna
Reference:
McElroy JA, et al. Support cancer. 2018; doi: 10,1007 / s00520-018-4383-y.
For more information:
Jane A. McElroy, PhD, can be reached at [email protected].
Jdonkey A. McElroy
According to a study conducted by researchers at the University of Missouri, the percentage of breast cancer patients who receive their diagnosis over the phone has increased dramatically over the past decade.
Jdonkey
A.
McElroy, PhD, Professor of Family and Community Medicine at the MU School of Medicine, and her colleagues invited women to participate in a survey to assess how the diagnosis was communicated to them. The survey also asked respondents to provide details about their diagnosis, their support system during treatment and their demographic information.
The results showed that about 70% of breast cancer diagnoses made between 1967 and 2000 had been communicated to patients in person.
However, the percentage of in-person diagnoses decreased over time. About two-thirds of survey respondents who were diagnosed with breast cancer between 2013 and 2017 received it over the phone.
Survey respondents who identified themselves as heterosexuals, reported having support members and were diagnosed with breast cancer in situ seemed more likely to receive a telephone notification.
HemOnc today discussed with McElroy about the study, possible explanations of the change in the communication of diagnoses and the consequences of the results.
Question: How did you
this study comes aboutand how did you drive it?
Reply: It was a kind of opportunistic analysis. We looked at the Women's Army of the Susan Love Research Foundation. There is a voluntary register of women interested in breast cancer research, some of whom have never had breast cancer. To prepare potential grant applications, we wanted to know how many women belonging to a sexual minority were in this group. The Women's Army sent an inquiry by email. We received approximately 6,000 responses, almost half of which (n = 2,896) were diagnosed with breast cancer. One of the questions asked those who had breast cancer how they had heard about their diagnosis. We did not expect the number of women diagnosed with breast cancer on the phone to increase by 60% after 2015 compared to 25% by 2007.
Q: What do you think is the cause of this increase?
A: I speculate, but I think it's because we're in the so-called digital era. We expect to hear information sooner. We have portals where doctors' notes about exams are posted and available to patients. The Health Information Technologies Act for Economic and Clinical Health allows the publication of results without the clinicians being custodians. This is the rapid dissemination of medical results. Doctors see the results 24 hours before the patient. This is the ideal focus for them to have a connection with the patient, especially if it is bad news. You can not call them and say, "Come in, see me this moment." People are busy. They are forced to make phone calls if they want to have this link with their patients.
Q: What should physicians consider before announcing bad news over the phone?
A: Giving bad news is about patient preferences. Some other qualitative studies have questioned patients about their preferences for receiving bad news and the results have been mixed. Some people are keen to receive the news as quickly as possible and then make an appointment to discuss next steps. Some people want to hear it in person. This is really about asking the doctor to check with the patient and establish a protocol to resolve it in advance. If the patient is going for a diagnosis, the doctor should have a conversation to ask him how he wants this information to be communicated.
Q:
University of Missouri
used these study results to modify the training of medical students. What's changed?
A: We have added a new component to our standard protocol by which we teach medical students how to announce bad news over the phone. It can be difficult to convey empathy to the patient, so how do you do it as best you can? A doctor can do a few simple things before embarking on a discussion about the test results. For example, the last thing to do is to announce bad news while driving. The first thing a provider needs to do to call a patient is to make sure he is in a safe place. It is also important to make sure they are in a private area. If someone picks up his phone in the middle of a meeting or at the grocery center, he hears the news in public. Doctors must also ask if the patient has time. Sometimes people pick up the phone as they head for the door and may not have the time to process the information at that time.
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Q: What is the next step of the research?
A: The next step is to determine what are the patient's preferences. We know that almost 60% of women are diagnosed with breast cancer by telephone. Is that what they prefer or does it happen because of circumstances even if it's not as they would like it to happen?
Q: Does this approach complement the growing focus on patient-centered care?
A: This certainly goes hand in hand with patient-centered care because it is patient-led. Many protocols are based on expert advice and not on patients. Traditionally, we followed what doctors or experts in the field thought was the best way to announce bad news. One of our recommendations is to start asking patients how they want the news to be delivered.
Q: Your study showed that 40% of
patients diagnosed with breast cancer in person were alone. What should doctors think about when they communicate bad news to someone who does not have support?
nobody with them
?
A: Again, it really depends on the patient. I recently saw a blog post in which someone said he preferred to receive his results by email because he would be at home and could process the information. They could then go to the doctor's office to discuss next steps. Some people get upset when the doctor insists that they hear the news in person. It's a complicated process for every individual. We tend to think that the best situation is that this information is delivered in person and that a person accompanied by the patient is supportive. For some people, that's not how they work. That's why it's so important to continue this research and understand these preferences. – by Joe Gramigna
Reference:
McElroy JA, et al. Support cancer. 2018; doi: 10,1007 / s00520-018-4383-y.
For more information:
Jane A. McElroy, PhD, can be reached at [email protected].
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