Are we meeting the informational needs of cancer patients and families? Perception of physician communication in pediatric oncology

Abstract

Background: High-quality oncology care is marked by skillful communication, yet little is known about patient and family communication perceptions or content preferences. Our study sought to elicit pediatric oncology patient and parent perceptions of early cancer communication to establish whether informational needs were met and identify opportunities for enhanced communication throughout cancer care.

Method: An original survey instrument was developed, pretested, and administered to 129 patients, age 10-18 years, and their parents at 3 cancer centers between 2011 and 2015. Statistical analysis of survey items about perceived communication, related associations, and patient/parent concordance was performed.

Results: A greater percentage of participants reported "a lot" of discussion about the physical impact of cancer (patients, 58.1% [n = 75]; parents, 69.8% [n = 90]) compared with impact on quality of life (QOL) (patients, 44.2% [n = 57]; parents, 55.8% [n = 72]) or emotional impact (patients, 31.8% [n = 41]; parents, 43.4% [n = 56]). One fifth of patients (20.9% [n = 27]) reported they had no up-front discussion about the emotional impact of cancer treatment. Parents indicated a desire for increased discussion regarding impact on family life (27.9% [n = 36]), long-term QOL (27.9% [n = 36]), and daily activities (20.2% [n = 26]). Patients more frequently than parents indicated a desire for increased physician/patient discussion around the impact on daily activities (patients, 40.3% [n = 52]; parents, 21.7% [n = 28]; P < .001), long-term QOL (patients, 34.9% [n = 45]; parents, 16.3% [n = 21]; P < .001), pain management (patients, 23.3% [n = 30]; parents, 7% [n = 9]; P < .001), physical symptom management (patients, 24% [n = 31]; parents, 7.8% [n = 10]; P < .001), short-term QOL (patients, 23.3% [n = 30]; parents, 9.3% [n = 12]; P = .001), and curative potential (patients, 21.7% [n = 28]; parents, 8.5% [n = 11]; P = .002, P values calculated using McNemar's test).

Conclusion: Oncologists may not be meeting the informational needs of many patients and some parents/caregivers. Communication could be enhanced through increased direct physician-patient communication, as well as proactive discussion of emotional symptoms and impact of cancer on QOL.

Keywords: clinical oncology; communication; parents; patients; pediatrics; perception; quality of life.

Figure 1.

Perceived physician/patient and physician/parent communication by way of response to the question: Before starting cancer treatment, did your/your child’s doctors (and or parents) discuss with you how the cancer treatments might.... a) make you/your child feel physically b) make you/your child feel emotionally c) affect your/your child’s quality-of-life Options: “yes, a lot”, “yes, a moderate amount”, “yes, a little”, “no” Note: Overall percentages may not sum to 100% because missing data is not shown in the figure.

Figure 2.

Perceived gaps in communication/opportunities for enhanced discussion by way of response to the question: (Select all that apply) Patient: What things do you wish that members of your oncology care team had discussed with you more or given you more information about? Parent: a) Parent for Child: What things do you wish that members of your child’s oncology care team had discussed with your child more or given your child more information about? b) Parent for Self: What things do you wish that members of your child’s oncology care team had discussed with you more or given you more information about?