Bridging Communication Between Breast Cancer Patients, Doctors

May 21, 2000
News Office: Eve Harris (415) 885-7277

A diagnosis of breast cancer is often shocking for patients. And deciding from the myriad of treatment options can be befuddling for patients, who often are still reeling from finding out they have cancer.

The Carol Franc Buck Breast Care Center at UCSF Medical Center has implemented a program to help physicians and patients wade through this process. The goals are to prepare patients for their upcoming consultations, to facilitate discussion and agreement on treatment options, and ensure patients leave consultation sessions understanding their choices and decisions.

"Patients often walk out overwhelmed with lots of complicated information and they don't know what do next," said Caryn Aviv, manager of the Collaborative Care Program at the medical center's Mount Zion location. "This program works to reduce communication barriers between patients and physicians."

Consultation Planning

Consultation planning is the first of two tools used by the program. Prior to a consultation with a Breast Care Center physician, Aviv meets with patients who are facing upcoming treatment decisions about surgery or post-surgery treatment options, such as mastectomy or lumpectomy, chemotherapy, radiation or hormonal therapies.

"What I do is work with them to clarify their questions, their concerns, their thoughts, fears and all the issues that are on their minds before actually meeting with their physician," Aviv said. "We flow chart that out, using mapping software to produce what's called a consultation plan."

Other studies have shown that patients often feel shy, confused, overwhelmed and sometimes defensive after being diagnosed with cancer. They often don't know what questions to ask doctors and this hampers collaborative decision making. Also, busy physicians often don't have the time or tools to discuss patients' fears and anxieties in depth, Aviv said. The consultation plan serves as a blueprint of what patients want to discuss during their medical consultation. Physicians receive a copy of the plan ahead of time.

"This is so they can anticipate what those questions might be and use the consultation plan to guide the discussion of treatment options based on the patient's preferences, beliefs and concerns," Aviv said.

Record and Summarize

The second tool is consultation recording in which Aviv records, condenses and summarizes what is said during the meeting. She lists treatment options, any statistics that were discussed, possible side effects and consequences of each option.

"I work with both the physician and patients in their meeting," she said. "We set an agenda based on the consultation plan and what the physician wants to go over. We work through all the different issues based on the patient's history and what's going on with their case and lay out treatment options."

Aviv facilitates the meeting, checking for understanding and identifying next steps in care based on the decisions patients and physicians reach together.

So far, Aviv has worked with 95 women through this program. Feedback has been positive. Patients say it helps clarify the information and organize their thoughts, and physicians find the plans and summaries useful, she said.

The program, which started in October, came as a result of a study conducted by Dr. Laura Esserman, a surgeon at the Breast Care Center, and Karen Sepucha, a recent PhD, from Stanford University's department of engineering-economic systems and operations research.

The study -- titled Building Bridges Between Physicians and Patients: Results of a Pilot Study Examining New Tools for Collaborative Decision Making in Breast Cancer -- was published in a recent edition of the Journal of Clinical Oncology. The study was a joint effort among Esserman, Sepucha, and Jeff Belkora, PhD, also from Stanford's engineering program, to develop decision support for patients facing high stakes, complex decisions.

"Another benefit is patients can take the recorded consultation home to their support network. They can refer to it and use it to explain to their family and friends what's going on and what kinds of decisions have been made and why," Aviv said. For more information, please call Aviv at (415) 353-7726.