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Communication in Cancer Care (PDQ®): Supportive care - Health Professional Information [NCI] - Important Outcomes of Communication

Patient Satisfaction

Patient satisfaction reflects how well patient health care needs, expectations, or preferences are met. The measurement of satisfaction with patient care is complicated by a patient bias to skew responses in favor of high satisfaction scores. In oncology, some studies support the concept that communication skills are related to patient satisfaction in several areas. Specifically, several studies relate patient satisfaction to psychological adjustment, including patient satisfaction with the amount and kind of information provided at the time of diagnosis;[1] clinician willingness to discuss treatment options;[2] patient perception of the oncologist as caring, attentive, or emotionally supportive;[3,4,5] and patient rating of communication with the physician. Basic communication skills have also been related to satisfaction in other studies,[6,7] which have demonstrated that among gynecology and medical oncology patients, satisfaction was associated with attentiveness, interest, and friendliness and with providing information. These findings among oncology patients parallel those found in other medical specialties.

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Informed Consent

Informed decision making is an essential component of the ethical practice of prescribing cancer treatments and conducting research. However, fully involving patients in clinical decision making is a challenging task for physicians, who nonetheless have been urged in recent years to take a less legalistic and more interactive approach with patients in explaining treatments.[8,9] The aim of informed consent is to emphasize more effective communication between patients and physicians, where information disclosure and patient participation in decision making are the goals rather than the notions of an administrative requirement to have patients sign a document or to protect a physician from legal liability.[10] A dialogue would also allow the clinician to determine how much information a patient actually desires and would respect the patient's right to shun information that might be unwanted.[10,11]

There are few data to describe how oncologists practice informed consent, and there are inadequate guidelines for communicating with patients about treatment decisions.[12] The best information comes from studies of communication in clinical trials, which show that oncologists scored poorly on measures of the quality of the content of information provided to the patient and explanation of randomization, implicitly expressing favoritism of one treatment over another;[13] that physicians overestimate patient satisfaction with specific treatment information;[14] and that not all patients understand the unproven nature of the treatment.[15] Inflexibility in the timing of information may represent a physician barrier to clinical trial recruitment. For example, treatment of breast cancer for patients on clinical trials cannot begin until the patient has signed the informed consent form. This requirement effectively compels physicians to reveal information to patients soon after the diagnosis is confirmed. Sixty-one percent of the physicians in one study [16] explained that they would have preferred to tell patients about their diagnosis and prognosis in small increments. They argued that patients need time to absorb the shock of the diagnosis before hearing a detailed description of the uncertainty of treatment options, but that the need to obtain informed consent constrained their schedule for disclosure to patients.[16]

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