Information, communication, and cancer patients’ trust in the physician: what challenges do we have to face in an era of precision cancer medicine?

• Published in: Supportive care in cancer 2021-04, Vol.29 (4), p.2171-2178
• Main Authors: Pichler, Theresia, Rohrmoser, Amy, Letsch, Anne, Westphalen, C. Benedikt, Keilholz, Ulrich, Heinemann, Volker, Lamping, Mario, Jost, Philipp J., Riedmann, Kristina, Herschbach, Peter, Goerling, Ute
• Format: Article
• Language: English
• Subjects: Adult; Aged; Analysis; Antimitotic agents; Antineoplastic agents; Cancer; Cancer patients; Clinical decision making; Communication; Decision making; Drug therapy; Female; Humans; Male; Medical advice systems; Medical diagnosis; Medicine; Medicine & Public Health; Middle Aged; Neoplasms - therapy; Nursing; Nursing Research; Oncology; Original; Original Article; Pain Medicine; Patient education; Patients; Physician patient relationships; Physician-Patient Relations - ethics; Precision Medicine - methods; Qualitative Research; Rehabilitation Medicine; Targeted cancer therapy; Trust; Uncertainty; Whole Genome Sequencing - methods
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-020-05692-7

Purpose Despite promising achievements in precision cancer medicine (PCM), participating patients are still faced with manifold uncertainties, especially regarding a potential treatment benefit of molecular diagnostics (MD). Hence, MD poses considerable challenges for patient information and communication. To meet these challenges, healthcare professionals need to gain deeper insight into patients’ subjective experiences. Therefore, this qualitative study examined information aspects of MD programs in cancer patients. Methods In two German Comprehensive Cancer Centers, 30 cancer patients undergoing MD participated in semi-structured interviews on information transfer and information needs regarding MD. Additionally, patients provided sociodemographic and medical data and indicated their subjective level of information (visual analogue scale, VAS, 0–10). Results On average patients had high levels of information (mean = 7, median = 8); nevertheless 20% ( n  = 6) showed an information level below 5 points. Qualitative analysis revealed that patients show limited understanding of the complex background of MD and have uncertainties regarding their personal benefit. Further, patients described unmet information needs. Existential threat in awaiting the results was experienced as burdensome. To withstand the strains of their situation, patients emphasized the importance of trusting their physician. Conclusion The challenges in PCM consist in providing unambiguous information, especially concerning treatment benefit, and providing guidance and support. Therefore, psycho-oncology needs to develop guidelines for adequate patient communication in order to help healthcare providers and cancer patients to handle these challenges in the developing field of PCM.