How communication between cancer patients and their specialists affect the quality and cost of cancer care
Communication in cancer care is multidimensional and may affect patient treatment decision-making and quality of life. This study examined cancer patients’ perceptions of the communication with their cancer specialists and explored its impact on the care they received and the financial burden they experienced.
Semi-structured telephone interviews were conducted with 20 rural and 20 outer metropolitan Western Australians diagnosed with breast, lung, prostate or colorectal cancer. Thematic analysis using a phenomenological approach was undertaken to derive key themes regarding the communication experiences of the participants.
Four main themes emerged: information context, communication about treatment options and treatment providers, communication about costs of treatment and impact of communication on continuity of care. The quality of the communication experienced by participants was variable and in many cases sub-optimal. This affected their ability to undertake well-informed decisions regarding treatment and providers and led to substantial out-of-pocket expenses for several participants. Whilst participants differed in their information needs and expectations, most participants trusted clinicians’ treatment recommendations.
Our results raise concerns about the quality of communication cancer patients receive during treatment and the repercussions for their treatment decisions and out-of-pocket expenses. Clear treatment and cost communication could empower patients in choosing treatment and providers. However, these findings suggest patients must remain vigilant during consultations and discuss available treatment pathways and their financial dimension to avoid costly treatments or missing out on available financial aid.
KeywordsCancer Communication Supportive care Qualitative study Western Australia
The authors thank Ruth McConigley, Angela Ives, Sandy McKiernan and Violet Platt who were involved in the planning and conceptualisation of the study; Catalina Lizama who assisted with data collection; and Rachel Singer who transcribed the interviews. The authors wish to thank the staff at the Western Australian Cancer Registry for their support with the study.
CJ and CS designed the study; JN and HH conducted data collection; JN, HH, and NSA conducted the qualitative analysis; JN, NSA, HH, CJ, and CS contributed to the analysis and interpretation of the data; NSA and JN wrote the manuscript. All authors read and approved the final manuscript.
This research was funded by the Cancer Council of Western Australia and Western Australian Government Department of Health through the WA Cancer and Palliative Care Network.
Compliance with ethical standards
The authors declare that they have no competing interests. Study participants provided written informed consent. The study was undertaken in accordance with relevant ethical standards and guidelines and was approved by the WA Country Health Service Ethics Committee (#2014:10) and the Department of Health WA Human Research Ethics Committee (#2014/26). The authors have full control of the primary data and are able to provide access upon request if deemed appropriate by all investigators.
- 2.Epstein RM, Street RL, Jr (2007) Patient-centered communication in cancer care: promoting healing and reducing suffering https://healthcaredelivery.cancer.gov/pcc/monograph.html. Accessed 4 May 2016
- 8.PDQ Adult Treatment Editorial Board (2017) Financial toxicity (financial distress) and cancer treatment (PDQ®): patient version. National Cancer Institute (US) https://www.ncbi.nlm.nih.gov/books/NBK441635/. Accessed 24 Aug 2018
- 9.Australian Institute of Health and Welfare (2017) Cancer in Australia 2017. Cancer series no. 101. Cat. no. CAN 100. AIHW. https://www.aihw.gov.au/reports/cancer/cancer-in-australia-2017/contents/table-of-contents. Accessed 18 May 2017
- 10.Australian Institute of Health and Welfare (2017) Health expenditure Australia 2015–16. Health and welfare expenditure series no. 58. Cat. no. HWE 68. AIHW. https://www.aihw.gov.au/reports/health-welfare-expenditure/health-expenditure-australia-2015-16/data. Accessed 20 Nov 2017
- 11.Consumers Health Forum of Australia (2018) Out of pocket pain research report. https://chf.org.au/sites/default/files/20180404_oop_report.pdf. Accessed 12 April 2018
- 12.Economics DA (2017) Financial impacts of breast cancer in Australia. Deliotte. https://www2.deloitte.com/au/en/pages/economics/articles/financial-impact-breast-cancer-australia.html. Accessed 27 Sept 2017
- 13.Gordon LG, Beesley VL, Mihala G, Koczwara B, Lynch BM (2017) Reduced employment and financial hardship among middle-aged individuals with colorectal cancer. Eur J Cancer Care 26(5). https://doi.org/10.1111/ecc.12744
- 14.Gordon LG, Walker SM, Mervin MC, Lowe A, Smith DP, Gardiner RA, Chambers SK (2017) Financial toxicity: a potential side effect of prostate cancer treatment among Australian men. European Journal of Cancer Care. https://doi.org/10.1111/ecc.12392
- 16.Hamel LM, Penner LA, Eggly S, Chapman R, Klamerus JF, Simon MS, Stanton SC, Albrecht TL (2017) Do patients and oncologists discuss the cost of cancer treatment? An observational study of clinical interactions between African American patients and their oncologists. J Oncol Pract 13(3):e249–e258. https://doi.org/10.1200/JOP.2016.015859 CrossRefPubMedGoogle Scholar
- 20.Breast Cancer Network Australia (2018) State of the nation report. https://www.bcna.org.au/media/6656/sotn-report-lowres.pdf. Accessed 15 Jun 2018
- 21.Australian Bureau of Statistics (2017) 3101.0—Australian Demographic Statistics, Sep 2017. Australian Bureau of Statistics. http://www.abs.gov.au/ausstats/abs@.nsf/PrimaryMainFeatures/3101.0?OpenDocument. Accessed 1 May 2018
- 22.Australian Bureau of Statistics (2013) 4364.0.55.002—Australian Health Survey: health service usage and health related actions, 2011–12. http://www.abs.gov.au/ausstats/abs@.nsf/lookup/E334D0A98272E4DCCA257B39000F2DCF. Accessed 1 May 2018
- 23.Newton JC, Johnson CE, Hohnen H, Bulsara M, Ives A, McKiernan S, Platt V, McConigley R, Slavova-Azmanova NS, Saunders C (2018) Out-of-pocket expenses experienced by rural Western Australians diagnosed with cancer. Support Care Cancer 26:3543–3552. https://doi.org/10.1007/s00520-018-4205-2 CrossRefPubMedGoogle Scholar
- 24.Creswell JW (2007) Qualitative inquiry & research design: choosing among five approaches / John W. Creswell. Qualitative inquiry and research design. Sage Publications, Thousand OaksGoogle Scholar
- 25.Morse JM (1994) Designing funded qualitative researchGoogle Scholar
- 28.Cancer Council Australia (2014) Ideal oncology curriculum—communication skills—communication and counselling. Cancer Council Australia. https://wiki.cancer.org.au/oncologyformedicalstudents_mw/index.php?oldid=1590. Accessed 17 April 2018
- 29.National Cancer Institute (2018) Communication in Cancer Care (PDQ®)–health professional version. https://www.cancer.gov/about-cancer/coping/adjusting-to-cancer/communication-hp-pdq. Accessed 17 April 2018
- 30.Cancer Council Victoria Victorian Cancer Clinicians Communication Program. https://www.cancervic.org.au/for-health-professionals/training-education/vcccp. Accessed 19 November 2018 2018
- 31.Cancer Australia Communication skills training https://canceraustralia.gov.au/clinical-best-practice/cancer-learning/communication-skills-training. Accessed 19 Nov 2018 2018
- 32.van Dongen JJJ, de Wit M, Smeets HWH, Stoffers E, van Bokhoven MA, Daniels R (2017) “They are talking about me, but not with me”: a focus group study to explore the patient perspective on Interprofessional team meetings in primary care. Patient 10(4):429–438. https://doi.org/10.1007/s40271-017-0214-3 CrossRefPubMedPubMedCentralGoogle Scholar
- 33.Rocque R, Leanza Y (2015) A systematic review of patients’ experiences in communicating with primary care physicians: intercultural encounters and a balance between vulnerability and integrity. PLoS One 10(10):e0139577. https://doi.org/10.1371/journal.pone.0139577 CrossRefPubMedPubMedCentralGoogle Scholar
- 35.Sullivan R, Peppercorn J, Sikora K, Zalcberg J, Meropol NJ, Amir E, Khayat D, Boyle P, Autier P, Tannock IF, Fojo T, Siderov J, Williamson S, Camporesi S, McVie JG, Purushotham AD, Naredi P, Eggermont A, Brennan MF, Steinberg ML, De Ridder M, McCloskey SA, Verellen D, Roberts T, Storme G, Hicks RJ, Ell PJ, Hirsch BR, Carbone DP, Schulman KA, Catchpole P, Taylor D, Geissler J, Brinker NG, Meltzer D, Kerr D, Aapro M (2011) Delivering affordable cancer care in high-income countries. Lancet Oncol 12(10):933–980. https://doi.org/10.1016/S1470-2045(11)70141-3 CrossRefPubMedGoogle Scholar
- 39.Australian Government Department of Health (2018) Optimal cancer care pathways (OCPs). http://www.health.gov.au/internet/main/publishing.nsf/content/occp. Accessed June 2018 2018
- 41.Porter ME, Lee TH (2013) The strategy that will fix health care. Harv Bus Rev 91(10):1–9Google Scholar
- 42.Abrahams E, Balch A, Goldsmith P, Kean M, Miller AM, Omenn G, Sonet E, Sprandio J, Tyne C, Westrich K (2017) Clinical pathways: recommendations for putting patients at the Center of Value-Based Care. Clin Cancer Res 23(16):4545–4549. https://doi.org/10.1158/1078-0432.CCR-17-1609 CrossRefPubMedGoogle Scholar
- 43.Aranda S, Whittaker K (2018) Patient out-of-pocket expenses. Asia Pac J Clin Oncol 14(S7):50–90. https://doi.org/10.1111/ajco.13088
- 44.Monterosso L, Platt V, Krishnasamy M, Yates P, Bulsara C (2016) The cancer nurse coordinator service in Western Australia: perspectives of specialist cancer nurse coordinators. Aust J Adv Nurs 34(2):16Google Scholar