Journal of Clinical Oncology, Vol 18, Issue 6
(March), 2000: 1230-1238
© 2000 American Society for Clinical Oncology
Building Bridges Between Physicians and Patients: Results of a Pilot Study Examining New Tools for Collaborative Decision Making in Breast Cancer
By Karen R. Sepucha,
Jeffrey K. Belkora,
Debasish Tripathy,
Laura J. Esserman
From the Department of Engineering-Economic Systems and Operations Research, Stanford University, Stanford; University of California San Francisco; San Francisco Carol Franc Buck Breast Care Center, San Francisco, CA; and Community Breast Health Project, Palo Alto, CA.
Address reprint requests to Laura J. Esserman, MD, MBA, Carol Franc Buck Breast Care Center, 2356 Sutter St San Francisco, CA; email essermal{at}medcenter.ucsf.edu
PURPOSE: To present the results of a pilot study testing an intervention designed to improve the quality of medical consultations between breast cancer patients and physicians and, in particular, to report the effects of the intervention on the quality of treatment decisions, the quality of communication, and the satisfaction of patients and physicians.
PATIENTS AND METHODS: We enrolled 24 predominantly white, well-educated, early-stage breast cancer patients who were facing local or systemic treatment decisions in a sequential, controlled trial. All patients received a visit preparation session before the consultation in which a trained researcher helped patients organize their questions and concerns. In the control, a researcher observed the consultation. In the intervention, a researcher helped create an agenda, facilitated the discussion, and created a record of the consultation in real time. Valid and reliable surveys measured the quality of treatment decisions and satisfaction with the consultation.
RESULTS: Patients in the intervention achieved significantly higher final decision quality scores compared with control patients (median score, 14 v 10, respectively; P = .008) and a significantly higher level of intersubjective agreement with their physicians about decision quality (Cohen’s kappa, 0.49 v 0.285, respectively; P < .0001). Consultation recording methods did not affect the length of time required for the consultation.
CONCLUSION: Consultation recording methods provide a promising innovation for medical consultations. Further studies are warranted to broaden the findings, assess impacts on the quality of decisions, cost, and health, and develop practical ways to integrate consultation recording methods into clinics.
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