Rachel C Shelton1, Laura E Brotzman2, Danielle M Crookes3, Patrick Robles2, AIfred I Neugut3. 1. Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, USA. Electronic address: rs3108@cumc.columbia.edu. 2. Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, USA. 3. Department of Epidemiology, Columbia University Mailman School of Public Health, New York, USA.
Abstract
OBJECTIVE: Decision-making about adjuvant chemotherapy (ACT) for stage II colon cancer is complex, particularly in light of clinical uncertainty regarding treatment benefits. Little is known about provider communication and factors influencing decision-making and recommendations in this setting. METHODS: We recruited providers from six US cancer centers and hospitals who care for stage II colon cancer patients. Providers participated in a 30-45 minute interview. Transcripts of interviews were coded for qualitative analysis. RESULTS: We interviewed 42 providers (Oncologists: 52%; surgeons: 24%; nurses: 14%). Though most providers were aware of stage II colon cancer treatment guidelines, their use and communication of recommended guidelines was limited. Most reported tailoring delivery and content of their communication, often based on perceived patient education level, but patient involvement in decision-making varied. Findings highlight the complexity of, ACT decision-making, including the central role of providers and family members. CONCLUSIONS: Providers are not consistently following recommended guidelines for communicating about ACT among stage II colon cancer patients or eliciting patient preferences for involvement in treatment decisions. PRACTICE IMPLICATIONS: Given clinical uncertainty surrounding use of ACT for stage II colon cancer, efforts are needed to enhance guideline implementation, provider education, and communication to facilitate decision-making.
OBJECTIVE: Decision-making about adjuvant chemotherapy (ACT) for stage II colon cancer is complex, particularly in light of clinical uncertainty regarding treatment benefits. Little is known about provider communication and factors influencing decision-making and recommendations in this setting. METHODS: We recruited providers from six US cancer centers and hospitals who care for stage II colon cancerpatients. Providers participated in a 30-45 minute interview. Transcripts of interviews were coded for qualitative analysis. RESULTS: We interviewed 42 providers (Oncologists: 52%; surgeons: 24%; nurses: 14%). Though most providers were aware of stage II colon cancer treatment guidelines, their use and communication of recommended guidelines was limited. Most reported tailoring delivery and content of their communication, often based on perceived patient education level, but patient involvement in decision-making varied. Findings highlight the complexity of, ACT decision-making, including the central role of providers and family members. CONCLUSIONS: Providers are not consistently following recommended guidelines for communicating about ACT among stage II colon cancerpatients or eliciting patient preferences for involvement in treatment decisions. PRACTICE IMPLICATIONS: Given clinical uncertainty surrounding use of ACT for stage II colon cancer, efforts are needed to enhance guideline implementation, provider education, and communication to facilitate decision-making.
Authors: Kenneth L Kehl; Mary Beth Landrum; Neeraj K Arora; Patricia A Ganz; Michelle van Ryn; Jennifer W Mack; Nancy L Keating Journal: JAMA Oncol Date: 2015-04 Impact factor: 31.777
Authors: Aalok Kumar; Hagen F Kennecke; Daniel J Renouf; Howard J Lim; Sharlene Gill; Ryan Woods; Caroline Speers; Winson Y Cheung Journal: Cancer Date: 2014-10-20 Impact factor: 6.860
Authors: Noralie H Geessink; Eirik H Ofstad; Marcel G M Olde Rikkert; Harry van Goor; Jürgen Kasper; Yvonne Schoon Journal: Patient Educ Couns Date: 2018-06-13
Authors: Lauren P Wallner; Yun Li; M Chandler McLeod; Ann S Hamilton; Kevin C Ward; Christine M Veenstra; Lawrence C An; Nancy K Janz; Steven J Katz; Sarah T Hawley Journal: Cancer Date: 2017-06-22 Impact factor: 6.921
Authors: Laura E Brotzman; Danielle M Crookes; Jessica D Austin; Alfred I Neugut; Rachel C Shelton Journal: Transl Behav Med Date: 2021-10-23 Impact factor: 3.626