Patient-physician communication during outpatient palliative treatment visits - An observational study

Context Improving health-related quality of life (HRQL) is an important goa l of palliative treatment, but little is known about actual patient-physici an communication regarding HRQL topics during palliative treatment. Objectives To investigate the content of routine communication regarding 4 specific HRQL issues between oncologists and their patients and to identify patient-, physician-, and visit-specific factors significantly associated with discussion of such issues. Design Observational study conducted between lune 1996 and January 1998, Setting Outpatient palliative chemotherapy clinic of a cancer hospital in t he Netherlands, Participants Ten oncologists and 240 of their patients (72% female; mean ag e, 55 years) who had incurable cancer and were receiving outpatient palliat ive chemotherapy. Main outcome Measures Patient and physician questionnaires and audiotape an alysis of communication regarding daily activities, emotional functioning, pain, and fatigue during an outpatient consultation using the Roter Interac tion Analysis System. Results Physicians devoted 64% of their conversation to medical/technical i ssues and 23% to HRQL issues. Patients' communication behavior was divided more equally between medical/technical issues (41%) and HRQL topics (48%). Of the independent variables investigated, patients' self-reported HRQL was the most powerful predictor of discussing HRQL issues. Nevertheless, in 20 % to 54% of the consultations in which patients were experiencing serious H RQL problems, no time was devoted to discussion of those problems. In parti cular, these patients' emotional functioning and fatigue were unaddressed 5 4% and 48% of the time, respectively. Discussion of HRQL issues was not mor e frequent in consultations in which tumor response was evaluated. Conclusion Despite increasing recognition of the importance of maintaining patients' HRQL as a goal of palliative treatment, the amount of patient-phy sician communication devoted to such issues remains limited and appears to make only a modest contribution, at least in an explicit sense, to the eval uation of treatment efficacy in daily clinical practice.