Agreement between cancer patients and their radiation oncologist regarding diagnosis and prognosis disclosure experiences in Japan (#549)
Retrospective clinician surveys are often used for assessing the content of consultations. However, concordance between clinician and patient reports of prognosis is reportedly quite poor . The aim of this study was to establish agreement between Japanese radiotherapy patients’ perceived prognosis disclosure experiences, and the views of their radiation oncologist. Participants are currently being recruited from a large radiation therapy department in a single university hospital in Japan (intended sample to be recruited from April-August n = 200). Participants are asked to complete a touchscreen computer survey assessing demographic and disease factors, and their perceptions of psychosocial communication and care. In the first month of the study, forty patients have given written informed consent to complete the touchscreen tablet survey and to have their survey responses compared to their clinicians’ survey responses. Preliminary analysis from 28 completed patient-clinician survey pairs suggests that agreement between patients and clinicians on whether treatment aim is palliative or not is currently 96% (Cohen's κ = 0.6, 95% CI: 0.02, 1). However, of 24 completed patient-clinician survey pairs, 21% (95% CI: 7.1-42%) of patients reported that they had discussed life expectancy discussions with their radiation oncologist, whilst radiation oncologists report that they have discussed this with 71% (95% CI: 49-87%) of patients. The observed agreement between patients and clinicians on whether life expectancy has been discussed is currently only 42% (Cohen's κ = 0.1, 95% CI: -0.2, 0.3). Although agreement between Japanese cancer patients’ and clinicians on the aim of treatment is moderate, agreement about whether life expectancy has been discussed was found to be only slight. Clinical and research implications of this will be discussed.
- Goldstein NE, Concato J, Bradley EH, O'Leary JR, Fried TR. Doctor-Patient Communication about Prognosis: The Influence of Race and Financial Status. Journal of Palliative Medicine 2005;8(5):998-1004.