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Communication in surgical decision-making while managing metastatic bone disease: matching patient expectations with surgical goals

Supportive Care in Cancer volume 29, pages 1111–1119 (2021)Cite this article

Abstract

Background

There is a paucity of research examining how surgical decision-making for metastatic bone disease (MBD) can be optimized to improve quality of life (QOL) and functional outcomes, while accurately aligning with patient goals and expectations. The objective of this study was to survey and interview patients with MBD and support persons (PS), physicians, and allied health care providers (HCP) with the goal of identifying (1) important surgical issues related to MBD management, (2) discordance in perioperative expectations, and (3) perceived measures of success in the surgical management of MBD.

Methods

Utilizing a custom survey developed by HCP and patients with MBD, participants were asked to (1) identify important issues related to MBD management, (2) rank perceived measures of success, and (3) answer open-ended questions pertaining to the management of MBD.

Results

From the survey, increased life expectancy, minimizing disease progression, removal of local tumour, timely surgery after diagnosis, increased length of hospitalization, and physiotherapy access were all identified as significant discordant goals between PS and physicians/HCP. Conversely, there was an agreement between physicians and HCP who considered improved QOL and functional outcomes as most important goals. Structured homogenous-group workshops identified the need for (1) improved discussions of prognosis, surgical options, expectations, timelines, and resources, (2) the use of a care team “quarterback”, and (3) an increased use of multi-disciplinary treatment planning.

Conclusions

We feel this data highlights the importance of improved communication and coordination in treating patients with MBD. Further research evaluating how surgical techniques influence survival and disease progression in MBD is highly relevant and important to patients.

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Acknowledgments

The authors would like to gratefully acknowledge Alberta SPOR Support Units (Patient Engagement, Knowledge Translation, Research and Consultation Platforms) and University of Calgary Ward of the 21st Century for their expertise.

Funding

This work was funded by the Canadian Institutes of Health Research, the Alberta Health Services Cancer Strategic Clinical Network, and the Cumming School of Medicine at the University of Calgary.

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Affiliations

  1. McCaig Institute for Bone & Joint Health, Cumming School of Medicine Health Sciences Centre, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4N1, Canada

    Kristen I. Barton, Shannon K. T. Puloski & Michael J. Monument

  2. Section of Orthopaedics, Department of Surgery, University of Calgary, Calgary, Alberta, Canada

    Olesja Hazenbiller, Kayla Kashluba, Shannon K. T. Puloski & Michael J. Monument

  3. Ward of the 21st Century, Foothills Hospital, Calgary, Alberta, Canada

    Georgina Freeman

  4. Patient Research Partner Representative, Calgary, Alberta, Canada

    Melvin Ball & Abir Aboutaha

  5. Arnie Charbonneau Cancer Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

    Shannon K. T. Puloski & Michael J. Monument

Authors
  1. Kristen I. Barton
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  2. Olesja Hazenbiller
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  3. Georgina Freeman
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  4. Kayla Kashluba
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  5. Melvin Ball
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  6. Abir Aboutaha
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  7. Shannon K. T. Puloski
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  8. Michael J. Monument
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Corresponding author

Correspondence to Michael J. Monument.

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The authors declare that they have no conflict of interest.

Additional information

Melvin Ball is deceased. This paper is dedicated to his memory.

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Barton, K.I., Hazenbiller, O., Freeman, G. et al. Communication in surgical decision-making while managing metastatic bone disease: matching patient expectations with surgical goals. Support Care Cancer 29, 1111–1119 (2021). https://doi.org/10.1007/s00520-020-05595-7

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  • DOI: https://doi.org/10.1007/s00520-020-05595-7

Keywords

  • Metastatic bone disease
  • Surgical management
  • Decision-making
  • Health-related quality of life
  • Expectations