Agreement between patients' and radiation oncologists' cancer diagnosis and prognosis perceptions: A cross sectional study in Japan

• Published in: PloS one 2018-06, Vol.13 (6), p.e0198437-e0198437
• Main Authors: Mackenzie, Lisa Jane, Carey, Mariko Leanne, Suzuki, Eiji, Sanson-Fisher, Robert William, Asada, Hiromi, Ogura, Masakazu, D'Este, Catherine, Yoshimura, Michio, Toi, Masakazu
• Format: Article
• Language: English
• Subjects: Beliefs, opinions and attitudes; Biology and Life Sciences; Cancer; Cancer patients; Cancer therapies; Care and treatment; Clinical trials; Communication; Cross-Sectional Studies; Decision making; Diagnosis; Ethics; Female; Health aspects; Health care; Hospitals; Humans; Japan; Life Expectancy; Life span; Male; Medical diagnosis; Medical prognosis; Medicine; Medicine and Health Sciences; Neoplasms - diagnosis; Neoplasms - drug therapy; Nursing; Oncologists; Oncology; Palliative care; Patient Satisfaction; Patients; Physician-Patient Relations; Physicians; Practice; Prognosis; Public health; Quality of life; Radiation; Radiation Oncologists; Radiation therapy; Radiotherapy; Research and Analysis Methods; Self Report; Surveys and Questionnaires; Touch screens
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0198437

This study assessed agreement between radiation oncologist- and cancer patient-reported perceptions about cancer diagnosis, time since diagnosis, treatment purpose, and whether life expectancy had been discussed; and described preferences for prognosis discussions. Adult cancer patients receiving radiotherapy at a Japanese hospital were invited to complete a touchscreen tablet survey. Patient survey responses were linked and comparisons made with a survey completed by their radiation oncologist. Among 146 cancer patient-oncologist dyads, there was almost perfect agreement on cancer diagnosis (ĸ = 0.88, 95% CI: 0.82-0.94), substantial agreement on time since diagnosis (ĸ = 0.70, 95% CI: 0.57-0.83) and moderate agreement on whether treatment goal was curative or palliative (ĸ = 0.44, 95% CI: 0.28-0.57; all p's < 0.0001). Agreement about whether a life expectancy discussion had occurred was less than expected by chance (κ = -0.06, p = 0.9). Radiation oncologists reported that they had spoken to over two thirds of patients about this, whilst less than one third of patients stated that this discussion had occurred with their radiation oncologist. Over half of the patients who had not discussed life expectancy wanted to. Patients had variable preferences for whether they (80%), their radiation oncologist (78%) or their partner/family (52%) should decide whether they discuss their life expectancy. Although patient self-reported information about diagnosis and time since diagnosis appears to be reasonably accurate (compared with clinician-reported information), limitations of self-reported data about prognostic discussions were highlighted by poor agreement between patient- and clinician-reported information about whether prognostic discussions have occurred. Additional support is needed to improve prognosis communication and understanding in radiation oncology settings.