Clinician-patient communication in cancer care can influence patient treatment decisions, symptom management, quality of life and out-of-pocket expenses.
The aim of this study was to explore rural and outer-metropolitan cancer patients’ perspectives of the communication with their cancer specialists and what impact this had on their treatment decision-making, out-of-pocket costs, and experience navigating the health system.
Semi-structured telephone interviews were conducted with 20 rural and 20 outer-metropolitan Western Australian cancer patients diagnosed with breast (n=11), prostate (n=11), colorectal (n=11) and lung (n=7) cancer. Thematic analysis using a phenomenological approach was undertaken to derive key themes regarding the communication experiences of the participants.
Four themes were identified: information context; communication about treatment options and treatment providers; communication about costs of treatment; and impact of communication on continuity of care. Participants’ communication experiences were variable and in many cases did not meet their needs. This affected participants’ ability to undertake well-informed decisions regarding treatments and providers, and resulted in substantial out-of-pocket expenses for some participants. Many participants credited their care providers for the smooth transitions between different health providers and services. Navigation through the different interfaces of the health system proved challenging for some, particularly rural participants. Issues identified include lack of timely communication and gaps in communication between cancer specialists themselves, between specialists and patients, and between specialist and rural health providers.
Our results raise concerns about the quality of communication cancer patients receive, and the repercussions for their treatment decisions and out-of-pocket expenses. This study indicates that informative and well-timed clinician-patient communication conducted at an appropriate level could help health professionals to objectively assess patients’ needs and assist them with the treatment decision-making process and could empower patients in choosing treatment and providers, and thus ensure smooth transition of care across the care continuum.