Gaps in Quality Communication Reported by Cancer Survivors Leave More to Be Desired

The quality of communication between cancer survivors and their providers in the United States is suboptimal and is riddled with gaps, according to the results of a recent study by Neetu Chawla, PhD, MPH, Research Scientist, Division of Research, Kaiser Permanente Northern California, Oakland, and colleagues.¹

“Our findings provide valuable information from the patient perspective and are similar to the findings of previous studies demonstrating suboptimal communication about survivorship care planning from the provider perspective,” reported Dr Chawla and colleagues.

Using data from the 2011 Medical Expenditure Panel Survey Experiences with Cancer survey, Dr Chawla and colleagues assessed the quality of communications between 1202 adult cancer survivors and their providers regarding 4 areas of survivorship care, including follow-up care, support for social or emotional needs, late adverse effects from cancer therapy, and guidance related to lifestyle recommendations, such as diet, exercise, or smoking cessation.

The majority of the respondents were women, married, non-Hispanic white, aged ≥65 years, and had at least a college-level education. Overall, 42.6% of survivors reported having an excellent or a very good health status, and 80.9% had ≥3 provider visits annually.

Survey Questions

The survey was focused on the quality of the communication between providers and cancer survivors. Survivors were asked whether at any time since they were diagnosed with cancer, had any of their providers ever discussed with them:

1. The need for continuing follow-up even after completing your treatment
2. The possibility of having late or long-term side effects related to the cancer therapy they had received
3. Their emotional or social needs in relation to their cancer diagnosis or treatment
4. Recommendations for lifestyle changes related to diet, exercise, and quitting smoking.

The option for responses for each of these questions included “I don’t remember,” “Did not discuss at all,” “Briefly discussed,” and “Discussed in detail.”

Better Communication Needed

Approximately 33% of survivors reported that they were not given detailed communication regarding follow-up care, and more than 50% said they did not receive comprehensive communication about lifestyle recommendations, social or emotional needs, or late or long-term treatment adverse effects.

“In this population-based, nationally representative sample, we found that limited proportions of cancer survivors reported high-quality discussions with providers after diagnosis, ranging from 29% for emotional and social needs to 62% for follow-up care recommendations,” noted Dr Chawla and colleagues.

Overall, a substantial percentage of cancer survivors received no communication, with results varying by content area, for example, from 7.3% for follow-up care to 32.6% for emotional needs. Only 24.4% reported that the physician discussed all 4 of the content areas in detail, indicating that approximately 76% of cancer survivors had suboptimal communication experiences with their providers.

The examination of patient issues associated with the quality of patient–provider discussions revealed that detailed discussions in all 4 areas were more likely to occur in survivors who received more recent treatment than in long-term survivors in whom more time had passed since receiving therapy.

“The communication quality gaps experienced by cancer survivors in the U.S. imply the need for oncologists and primary care providers to more heavily emphasize communication clarity regarding follow up care, late or long-term treatment effects, lifestyle recommendations, and emotional or social needs as part of survivorship care planning,” noted Dr Chawla and colleagues.

Multiple efforts exist on a national level to address survivorship care planning with regard to cancer care delivery, such as the Center for Medicare and Medicaid Innovation’s Oncology Care Model, which aims to provide higher-quality, more coordinated and cost-effective cancer care to Medicare beneficiaries.

“Collectively, these greater efforts may yield improvements in survivorship care planning and communication between providers to enable better coordination of cancer care,” concluded Dr Chawla and colleagues.

Reference

1. Chawla N, Blanch-Hartigan D, Virgo KS, et al. Quality of patient-provider communication among cancer survivors: findings from a nationally representative sample. J Oncol Pract. 2016;12:e964-e973.