Download Terrance Albrecht - Association for Psychological Science

The Role of Physician-Patient
Communication in
Cancer Clinical Trials
Terrance Albrecht, Ph.D.
Professor
Department of Interdisciplinary Oncology
University of South Florida College of Medicine
H. Lee Moffitt Cancer Center & Research Institute
Institute of Medicine Report
Ensuring Quality Cancer Care (1999)
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Recommendation #4:
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“Improve access to high quality clinical trials”
“Improve policies to ensure full disclosure of
information about appropriate treatment
options”
Response by NCI:
“Begin learning how patients obtain
information,identifying their preferences for
information and developing communication
‘products’ to help consumers, cancer patients,
survivors and families make better informed
treatment decisions”
The Problem
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Clinical trials are the means for finding the best
treatments and cures for cancer; however:
 Insufficient numbers of patients on studies
 Under-representation of minority and elderly
populations
 Unmet needs of patients, family
members/significant others, and physicians
 Wide variation in physician communication
behavior
 Negative press reports create resistance from
eligible patients and families
Funding
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Preliminary studies supported by the H.Lee
Moffitt Cancer Center and Research Institute,
#G80502 (1993-2000).
Current grant: “Effects of Physician
Communication on Patient Accrual,”
RO1 CA75003-01A3, NCI, 4/01/01 – 3/31/04.
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Collaborators
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John Ruckdeschel, M.D.
Dawn Riddle, Ph.D.
Michael Coovert, Ph.D.
Louis Penner, Ph.D.
Gerald Barbosa, M.D.
Benjamin Djulbegovic, M.D., Ph.D.
James Helm, M.D., Ph.D.
Christina Blanchard, MSSW, Ph.D.
Gwendolyn Quinn, Ph.D.
1See
selected publications
Reasons Patients Do or Do Not
Enroll in Cancer Clinical Trials
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DO ENROLL:
Trust in their physician
Physician recommended study
Physician responsive to
questions and issues
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Encouragement by family
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Manageable side effects
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Altruism
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Desire to live
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DO NOT ENROLL:
Perceive their needs not
physician’s priority
Disrupt quality of life, functional
abilities
Anxiety about randomization
Worry might not receive best
treatment
Concern about logistical difficulties
Perceive insurance problems
Concern about excessive toxicity
Poor understanding of study
Family against study participation
Worry about excessive burden on
family/friends
Current NCI Grant
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Previously found:
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Physician communication--style and content-linked to patients’ treatment decisions choices
Disconnect between what we think occurs and
what actually occurs in MD-PT encounters
Still need to demonstrate impact of
communication on patient’s treatment
decision making--compared to other
determinants—What determines patient
choice?
Expect the presence of a family member
complicates the interaction
Model of Patient Decision Making
Patient
Family
Member
Communication
Communication
Physician
Study Protocol
Treatment
Decision
How to Study the Complex
Process of Communication
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Design/create original digital video recording,
editing suite, and analysis system
Five criteria for recording system:
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Capture audio and video
Portable/economical
Unobtrusive
Protect human subjects’ confidentiality
Provide concrete evidence of specific behaviors
that comprise effective MD-PT communication
Communication for Improving
Quality Cancer Care
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Train physicians to:
 Invite/elaborate patient/family member
questions
 Check patient/family knowledge--offer
culturally and linguistically appropriate
explanations
 Encourage information record
 Become well versed in types of available
services
 Provide social support and hope
Current and Future Directions
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Investigations to develop
communication strategies for:
Increasing quality of life and survivorship—
(example: Assisting parents of children
undergoing painful procedures)
 Improving public education about genetic
risks
 Reducing health disparities in cancer care
for minority/underserved patients
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