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Patient-clinician communication among patients with stage I lung cancer

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Abstract

Purpose

Limited data exist about patient-centered communication (PCC) and patient-centered outcomes among patients who undergo surgery or stereotactic body radiation therapy (SBRT) for stage I non-small cell lung cancer (NSCLC). We aimed to examine the relationship between PCC and decision-making processes among NSCLC patients, using baseline data from a prospective, multicenter study.

Methods

Patients with stage 1 NSCLC completed a survey prior to treatment initiation. The survey assessed sociodemographic characteristics, treatment decision variables, and patient psychosocial outcomes: health-related quality of life (HRQOL), treatment self-efficacy, decisional conflict, and PCC.

Results

Fifty-two percent (n = 85) of 165 individuals planned to receive SBRT. There were no baseline differences detected on patient psychosocial outcomes between those who planned to receive SBRT or surgery. All participants reported high HRQOL (M = 72.5, SD = 21.3) out of 100, where higher scores indicate better functioning; high self-efficacy (M = 1.5, SD = 0.5) out of 6, where lower numbers indicate higher self-efficacy; minimal decisional conflict (M = 15.2, SD = 12.7) out of 100, where higher scores indicate higher decisional conflict; and high levels of patient-centered communication (M = 2.4, SD = 0.8) out of 7 where higher scores indicate worse communication. Linear regression analyses adjusting for sociodemographic and clinical variables showed that higher quality PCC was associated with higher self-efficacy (β = 0.17, p = 0.03) and lower decisional conflict (β = 0.42, p < 0.001).

Conclusions

Higher quality PCC was associated with higher self-efficacy and lower decisional conflict. Self-efficacy and decisional conflict may influence subsequent health outcomes. Therefore, our findings may inform future research and clinical programs that focus on communication strategies to improve these outcomes.

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Acknowledgements

The authors thank the following: VA Portland Health Care System: Mark E. Deffebach, M.D., Mithran S. Sukumar, M.D., and Sujata Thakutra, M.P.A.:H.A.; Oregon Health & Science University: Paul H. Schipper, M.D., Brandon H. Tieu, M.D., Charles R. Thomas Jr., M.D., Charlotte Kubicky, M.D., Ph.D., and John Holland, M.D.; Legacy Health System: Andrew Y. Kee, M.D., and Andrew C. Tsen, M.D.; Providence Health & Services: John R. Handy Jr., M.D., Hon.D., and Steven Seung, MD, Ph.D., FACR; PeaceHealth Southwest Washington Medical Center: Michael A. Myers, M.D., and Dennis L. Febinger, M.D.; Tuality Healthcare: Timur Mitin, M.D., Ph.D., and Srinivas R. Mummadi, M.D., FCCP; and Kaiser Permanente: Kelli D. Salter, M.D., Ph.D., David G. Tse, M.D., and Thomas D. Wynne, M.D.

Funding

This study is supported by an award from the Radiation Oncology Institute (no. ROI2013-915, Radiation Therapy & Patient-Centered Outcomes among Lung Cancer Patients). It was also supported by resources from the VA Portland Health Care System, Portland, Oregon and the Hunter Holmes McGuire Veteran Affairs Medical Center, Richmond, Virginia. Dr. Slatore was supported by a VA HSR&D Career Development Award (CDA 09-025) while the current study was ongoing. Dr. Moghanaki is supported by the VA Cooperative Studies Program (CSP no. 2005).

The Department of Veterans Affairs did not have a role in the conduct of the study; in the collection, management, analysis, or interpretation of data; or in the preparation of the manuscript. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the US Government.

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Authors and Affiliations

  1. Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D66), 3710 SW US Veterans Hospital Road, Portland, OR, 97239, USA

    Shannon M. Nugent, Sara E. Golden & Christopher Slatore

  2. Division of Psychiatry, Oregon Health & Science University, Portland, OR, USA

    Shannon M. Nugent

  3. Department of Radiation Medicine, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA

    Charles R. Thomas Jr & Christopher Slatore

  4. Division of Pulmonary & Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, USA

    Mark E. Deffebach & Christopher Slatore

  5. Section of Pulmonary & Critical Care Medicine, VA Portland Health Care System, Portland, OR, USA

    Mark E. Deffebach & Christopher Slatore

  6. Division of Cardiothoracic Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR, USA

    Mithran S. Sukumar, Paul H. Schipper & Brandon H. Tieu

  7. Division of Clinical Research, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, USA

    Drew Moghanaki

  8. Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA

    Juan Wisnivesky

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  1. Shannon M. Nugent
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  2. Sara E. Golden
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  10. Christopher Slatore
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Contributions

All authors have made substantial contributions to the conception and design, acquisition of data, or analysis and interpretation of data; have contributed to drafting the article for important intellectual content; and have provided final approval of the version to be published.

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Correspondence to Shannon M. Nugent.

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Nugent, S.M., Golden, S.E., Thomas, C.R. et al. Patient-clinician communication among patients with stage I lung cancer. Support Care Cancer 26, 1625–1633 (2018). https://doi.org/10.1007/s00520-017-3992-1

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