Photo by Rhoda Baer
Doctor consults with cancer patient and her father
Better communication between cancer patients and healthcare providers may provide tangible benefits, according to research published in JNCCN.
Cancer survivors who reported greater satisfaction in communicating with healthcare providers had better general health and mental health, fewer doctor visits, and reduced healthcare spending, when compared to patients who were less satisfied with communication.
“Our study suggests that when cancer care providers are more effective communicators, their patients are more likely to follow medical advice and medication protocols,” said study author Ashish Rai, PhD, of the American Cancer Society in Framingham, Massachusetts.
For this study, Dr Rai and his colleagues analyzed data from the Medical Expenditure Panel Survey (MEPS) from 2008 through 2014.
The researchers evaluated 4588 cancer survivors, dividing them into non-elderly and elderly groups. The non-elderly patients (n=2257) had a median age of 54 (range, 18-64), and the elderly patients (n=2331) had a median age of 75.
Communication satisfaction was measured by the Consumer Assessment of Healthcare Providers and Systems (CAHPS), in conjunction with the MEPS data.
Patients used a 4-point scale ranging from “never” to “always” to track whether their providers did the following:
- Listened carefully
- Explained things in a way that was easy to understand
- Showed respect for what the respondent had to say
- Spent enough time with the respondent.
A global satisfaction rating scale (0 to 10) was factored into a composite score and tracked across 12 months.
The researchers then assessed various patient outcomes.
Satisfaction and outcomes
Overall, patients who were the most satisfied with communication had the best outcomes with regard to general, physical, and mental health; fewer emergency department, hospital, and office visits; and reduced drug, out-of-pocket, and total healthcare expenditures.
However, the associations between communication satisfaction and outcomes were not always significant.
In an adjusted analysis, the elderly patients who were more satisfied with communication in year 1 had significantly better outcomes in year 2 for general health, mental health, and total healthcare expenditures.
| Elderly patients 65+ | |||
| Least satisfied
(tertile 1) |
Moderately satisfied (tertile 2) | Most satisfied
(tertile 3) |
|
| Excellent/very good general health | |||
| Unadjusted proportion | 23.6% | 31.8% | 45.8% |
| Predictive margin | 30.3
(95% CI 26.0–34.6) |
32.2
(95% CI 28.9–35.5) |
38.9
(95% CI 35.1–42.7) |
| P value | Reference | 0.466 | 0.007 |
| Highest quartile of mental health | |||
| Unadjusted proportion | 22.9% | 34.8% | 41.7% |
| Predictive margin | 27.1
(95% CI 22.1–32.1) |
35.5
(95% CI 31.5–39.5) |
37.0
(95% CI 32.7–41.4) |
| P value | Reference | 0.013 | 0.005 |
| Total healthcare expenditure | |||
| Unadjusted mean | $33,558 | $27,341 | $29,591 |
| Predictive margin | $34,071 ($29,011–$39,131) | $28,230 ($22,907–$33,553) | $26,995 ($22,568–$31,422) |
| P value | Reference | 0.301 | 0.049 |
For the non-elderly patients, those who were more satisfied with communication in year 1 had significantly better outcomes in year 2 for physician office visits and mental health.
| Non-elderly patients (18-64) | |||
| Least satisfied (tertile 1) | Moderately satisfied (tertile 2) | Most satisfied (tertile 3) | |
| Total physician office visits | |||
| Unadjusted mean | 7.96 | 6.96 | 5.85 |
| Predictive margin | 7.42
(95% CI 6.78–8.06) |
6.60
(95% CI 5.98–7.22) |
6.26
(95% CI 5.47–7.05) |
| P value | Reference | 0.211 | 0.038 |
| Highest quartile of mental health | |||
| Unadjusted proportion | 23.5% | 35.5% | 41.1% |
| Predictive margin | 29.7
(95% CI 25.3–34.1) |
36.0
(95% CI 31.3–40.7) |
34.0
(95% CI 29.5–38.4) |
| P value | Reference | 0.036 | 0.187 |
Baseline health and satisfaction
In both age groups, patients with better baseline health reported higher satisfaction with communication. Conversely, the more comorbidities patients had, the lower their satisfaction rating.
The researchers said this suggests that more complex circumstances negatively impacted patients’ perception of their communication, and the finding highlights the importance of coordinating care across a team of providers.
“The results of this study present an interesting challenge: those survivors most in need of good communication about complex medical issues may not be receiving the information they seek in a manner that they find helpful. That, in turn, results in higher healthcare utilization and expenditure,” said Crystal Denlinger, MD, of Fox Chase Cancer Center in Philadelphia, Pennsylvania, who was not involved in this study.
“This could be due to many factors, including time constraints, competing priorities, and increasingly complex cancer therapies. This study highlights the need for additional research into how to tailor the healthcare experience both during and after cancer treatment in order to communicate more effectively.”
Conclusions
“Communication needs vary from patient to patient,” Dr Rai noted. “While time constraints do pose a challenge, the amount of time spent is only one of the attributes of effective communication. By tailoring their communication strategy to a patient’s specific needs, providers may be able to communicate more effectively in the same amount of time.”
Dr Rai also pointed out the importance of delegating both clinical and communication duties as needed. Dr Rai and his colleagues also cited earlier research demonstrating better outcomes for patients who had the option of communicating with their provider electronically.1,2
Ultimately, the researchers concluded that effective provider communication can improve outcomes by streamlining care, alleviating anxiety, boosting mutual trust, and increasing treatment adherence.
1. Basch E, Deal AM, Dueck AC, et al. Overall survival results of a trial assessing patient-reported outcomes for symptom monitoring during routine cancer treatment. JAMA 2017;318:197–198.
2. Smith AB, Basch E. Role of patient-reported outcomes in postsurgical monitoring in oncology. J Oncol Pract 2017;13:535–538.