Information Needs Expressed During Patient-Oriented Oncology Consultations: Quantity, Variation, and Barriers

  • Anesa AhamadEmail author
  • Paul Wallner
  • Sharon Salenius
  • Rudi Ross
  • Eduardo Fernandez


High-quality oncology consultation includes patient-oriented communication tailored to patients’ individualized needs. Common methods used in studies to increase question-asking are prompt lists and coaching pre-consultations. However, our patients were encouraged to ask questions by the physician during their visit. We aimed to estimate the quantity, nature, and variation of their questions when they were invited to ask by their oncologist. During radiotherapy consultations from 2012 to 2016, patient’s questions were deliberately elicited and physician-transcribed. We derived mean and median number of questions per patient, variance by patient factors, and a taxonomy of subjects using thematic analysis. Three hundred ninety-six patients asked 2386 questions, median asked per patient = 6 (interquartile range = 4). We found significant variance with age (mean = 6.9 questions for < 60 years, 5.4 for ≥ 70 years) p = 0.018, insurance type (mean = 4.7 for Medicaid, 7.2 for private insurance) p = 0.0004, and tumor site (mean number of questions: skin = 4.6, lymphoma = 5.2, lung = 5.8, breast = 6.1, prostate = 6.3, rectum = 6.7 head and neck = 6.9, brain = 7.0, bladder = 7.2, anus = 8.8, others = 5.8) p = 0.0440. Of the diverse set of 57 topics, the commonest were 1. logistics, 2. radiotherapy details, 3. side effects, 4. diagnosis, and 5. stage and prognosis. Only 17 topics were asked by more > 10% of patients and 40 topics were asked by < 10% of patients. With median of 6 questions, it is practicable to routinely elicit and address individualized information needs. Potential barriers may be older and underinsured patients. The wide variety of topics, often pertaining to individuals’ case, suggests that cancer clinicians should take time-out during consultation to elicit patients’ questions to accomplish best-practice communication.


Cancer Oncology Communication Patient-oriented communication Radiotherapy Personalized medicine Nature of information needs Quantity of information need Patient-reported information needs Variation of information needs Patient-centered communication Frequently asked radiotherapy questions Barriers to communication, question-asking 



We wish to thank April Mann, Writing Center Director, Senior Lecturer, College of Arts and Sciences, Department of English, University of Miami for her painstaking guidance in writing the manuscript.

An abstract of this paper in part was published at the Annual Meeting of the American Society of Clinical Oncology, 2017.

An abstract of this paper in part was presented at the Annual Meeting of the American Society of Radiation Oncology, 2017

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Roter DL (1977 Winter) Patient participation in the patient-provider interaction: the effects of patient question asking on the quality of interaction, satisfaction and compliance. Health Educ Monogr 5(4):281–315. CrossRefPubMedGoogle Scholar
  2. 2.
    Kinnersley P, Edwards A, Hood K et al (2007) Interventions before consultations for helping patients address their information needs. Cochrane Database Syst Rev 3:CD004565Google Scholar
  3. 3.
    Foley AK, Foley KA, Feldman-Stewart D et al (2016) What aspects of personal care are most important to patients undergoing radiation therapy for prostate cancer? Int J Radiation Oncol Biol Phys 94(2):280–288. CrossRefGoogle Scholar
  4. 4.
  5. 5.
    Stewart MA, IR MW, Buck CW (1979) The doctor-patient relationship and its effect upon outcome. J R Coll Gen Pract 29:77–82PubMedPubMedCentralGoogle Scholar
  6. 6.
    Maguire P, Faulkner A, Booth K, Elliott C, Hillier V (1996) Helping cancer patients disclose their concerns. Eur J Cancer 32A(1):78–81CrossRefPubMedGoogle Scholar
  7. 7.
    Razavi D, Delvaux N, Marchal S et al (2002) Does training increase the use of more emotionally laden words by nurses when talking with cancer patients? A randomised study. Br J Cancer 87:1–7CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Ford S, Fallowfield L, Lewis S (1996) Doctor–patient interactions in oncology. Soc Sci Med 42(11):1511–1519. CrossRefPubMedGoogle Scholar
  9. 9.
    Chapman K, Abraham C, Jenkins V et al (2003) Lay understanding of terms used in cancer consultations. Psychooncology 12:557–566CrossRefPubMedGoogle Scholar
  10. 10.
    Fallowfield L, Lipkin M, Hall A (1998) Teaching senior oncologists communication skills: results from phase I of a comprehensive longitudinal program in the United Kingdom. J Clin Oncol 16(5):1961–1968. CrossRefPubMedGoogle Scholar
  11. 11.
    Warren E, Footman K, Tinelli M, McKee M, Knai C (2014) Do cancer-specific websites meet patient's information needs? Patient Educ Couns 95(1):126–136. CrossRefPubMedGoogle Scholar
  12. 12.
    Boyatzis RE (1998) Transforming qualitative information: thematic analysis and code development. SAGE Publications IncGoogle Scholar
  13. 13.
    DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Parts 414 and 495 [CMS-5517-FC] RIN 0938-AS69 Medicare Program; Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models, October 2016Google Scholar
  14. 14.
    Lerman C, Daly M, Walsh WP et al (1993) Communication between patients with breast cancer and health care providers: determinants and implications. Cancer 72:2612–2620CrossRefPubMedGoogle Scholar
  15. 15.
    Razavi D, Delvaux N, Marchal S et al (2000) Testing health care professionals’ communication skills: the usefulness of highly emotional standardized role-playing sessions with simulators. Psychooncology 9:293–302CrossRefPubMedGoogle Scholar
  16. 16.
    Loge JH, Kaasa S, Hytten K (1997) Disclosing the cancer diagnosis: the patients’ experiences. Eur J Cancer 33(6):878–882. CrossRefPubMedGoogle Scholar
  17. 17.
    Epstein R, Street RL Jr. Patient-centered communication in cancer care: promoting healing and reducing suffering 07–6225,2007 Bethesda, MD National Cancer Institute, NIH publicationGoogle Scholar
  18. 18.
    Fallowfield L, Solis-Trapala I, Langridge CI et al (2011) Evaluation of an intervention to improve communication about phase I/II trials. J Clin Oncol 29(15_suppl):6028CrossRefGoogle Scholar
  19. 19.
    Shapiro RS, Simpson DE, Lawrence SL, Talsky AM, Sobocinski KA, Schiedermayer DL (1989) A survey of sued and non-sued physicians and suing patients. Arch Intern Med 149(10):2190–2196. CrossRefPubMedGoogle Scholar
  20. 20.
    Fallowfield L (1995) Can we improve the professional and personal fulfilment of doctors in cancer medicine? Br J Cancer 71(6):1132–1133. CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Wang SY, Kelly G, Gross C et al (2017) Information needs of older women with early-stage breast cancer when making radiation therapy decisions. Int J Radiat Oncol Biol Phys 98(4):733–740CrossRefPubMedGoogle Scholar
  22. 22.
    Eggly S, Harper FW, Penner LA et al (2011) Variation in question asking during cancer clinical interactions: a potential source of disparities in access to information. Patient Educ Couns 82(1):63–68. CrossRefPubMedGoogle Scholar
  23. 23.
  24. 24.
    Gilligan T, Bohlke K, Baile WF (2017) Patient-clinician communication: American Society of Clinical Oncology Consensus Guideline Summary. J Oncol Pract 15:JOP2017027144. Google Scholar
  25. 25.
    Cherny NI, de Vries EG, Emanuel L et al (2014) Words matter: distinguishing “personalized medicine” and “biologically personalized therapeutics”. J Natl Cancer Inst 106(12):dju321. CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© American Association for Cancer Education 2018

Authors and Affiliations

  1. 1.Department of Radiation Oncology21st Century OncologyKey WestUSA
  2. 2.University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer CenterLennar Foundation Medical CenterCoral GablesUSA
  3. 3.Department of Radiation Oncology21st Century OncologyMoorestownUSA
  4. 4.Department of Research and Education21st Century OncologyFort MyersUSA
  5. 5.Department of Radiation Oncology21st Century OncologyPlantationUSA

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