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OBJECTIVE: Women with early-stage, ER+ breast cancer are recommend to receive genomic profiling tests, such as the 21-gene Recurrence Score (RS) test, to guide treatment decisions. We examined test- and treatment-related information discussed and the associations between RS categories and aspects of communication during patient-oncologist clinical encounters. METHODS: As part of a larger trial, clinical encounters (N=46) were audiorecorded and coded for 1) RS- and treatment-related information, 2) shared decision making, 3) patient active participation, and 4) oncologist patient-centered communication. We examined differences by RS category using mixed models, adjusting for nesting within oncologist. RESULTS: Patients with a high RS were more likely to receive a chemotherapy recommendation (p

PURPOSE: The 21-gene recurrence score (RS) assay is used to guide breast cancer treatment decisions but can be poorly understood by patients. We examined the effects of a question prompt list (QPL) on knowledge, distress, and decisional conflict related to genomic testing and treatment in early-stage breast cancer. METHODS: We describe the feasibility and acceptability of the QPL and the impact of the QPL on knowledge, distress, and decisional conflict before and after the receipt of the QPL (MEND 2, N = 65). We also compared distress and decisional conflict between women who received the QPL (MEND 2, N = 65) and a comparable group of women who did not receive the QPL who participated in an earlier observational study within the same clinics (MEND 1, N = 136). RESULTS: MEND 2 participants indicated high acceptability and feasibility using the QPL. Knowledge increased post-QPL ( P < .01) but did not decrease distress. Decisional conflict was lower among women in MEND 2 compared with those in MEND 1 ( P < .01), with no statistically significant differences in distress. CONCLUSION: The findings suggest that the QPL is feasible, acceptable, can improve knowledge and decrease decisional conflict in the large group of women deciding treatment while integrating RS test results.

Objectives Question Prompt Lists (QPL) increase patient active participation in oncology interactions, but questions remain regarding how QPLs influence patient-oncologist information exchange. We examined how a QPL influenced information exchange during oncology interactions with African-American patients. Methods Data were self-reports and video recordings from a parent study testing the effects of a QPL in the outpatient clinics of two urban cancer hospitals. In this secondary analysis, we investigated which QPL questions patients identified as ones they wanted to ask their oncologists, how frequently patients/companions used patient active participation statements to seek information related to each QPL question, whether oncologists provided QPL-related information unprompted or prompted by patients/companions, and how frequently patients’ QPL-related information needs were addressed or unaddressed. Results The QPL influenced information exchange by increasing patients’ and companions’ (if present) prompting for QPL-related information from their oncologists. Patients/companions most often prompted for QPL-related information about side effects and patient experience. Conclusion This study builds on prior research on QPL interventions by expanding the object of study to information exchange and by analyzing patients’ information needs. Practice implications This research demonstrates that a QPL supports patient/companion participation in oncology consultations by making information exchange more interactive.

Objective This study examines the preferences of patients with metastatic cancer regarding notification of imaging results, as well as distress surrounding the process. Methods On imaging day, preferences for notification, expectations of results, health literacy, and social support were measured. After receiving results, patients reported on actual delivery methods. At both times, patients were screened for overall distress, anxiety, and depression. Results The majority of patients preferred notification within 2 days and during a face-to-face visit with their oncologist. Although levels of distress, anxiety, and depression were low, patients with higher anxiety, depression, and social isolation had higher distress. There was no correlation between absolute distress levels and agreement between notification preferences and actual delivery methods. Receiving results from a preferred provider was associated with a decrease in distress from imaging day to follow-up. Face-to-face delivery of results was more important to people with lower health literacy. Conclusions While distress regarding the receipt of results was low, it was higher for some groups of patients. Attending to the preferences of these subgroups may help to minimize distress. Practice implications Receiving results from preferred personnel and diminishing patients' sense of social isolation might provide psychological benefit during the period surrounding imaging.

PurposeClinical trials are critical to advancing cancer treatments, yet their impact is hindered by low accrual rates, especially among minorities. One barrier is the quality of physician communication during clinical interactions in which trials are discussed. We describe the development and pilot test of a physician-focused, web-based training module designed as an intervention to improve physician communication related to discussing clinical trials in a diverse cancer patient population. The purpose of the pilot test was to assess acceptability and preliminary effectiveness in improving physician beliefs, attitudes, knowledge, and comfort related to discussing cancer clinical trials with patients and families in a diverse patient population.MethodA team of researchers, clinicians, and community members developed the training module based on current communication research and analysis of an archive of video-recorded patient-oncologist interactions. The module included a brief didactic video explaining patient-centered communication strategies for discussing trials, and re-enactments of selected video clips from the archive to provide illustrations and guide opportunities for reflection. For the pilot test, the module was provided to physician participants in the Partnering Around Cancer Clinical Trials (PACCT) trial at two NCI-designated comprehensive cancer centers. Pre-post measures included assessments of change in beliefs, behavioral attitudes, knowledge and comfort related to discussing trials; measures also assessed evaluations of the module. ResultsNineteen physicians participated in the pilot test of the module. Most were very experienced in discussing trials. Pre-post assessments indicated mixed findings about beliefs, marginal improvement in attitudes, and a significant improvement in knowledge, but no change in comfort discussing trials. Feedback on the module was favorable. ConclusionsThis pilot test of a stakeholder-developed physician communication training module demonstrated its acceptability and effectiveness, even in this highly-experienced physician sample. Future research is needed to determine its effectiveness on communication in clinical settings. Trial Registration Number NCT02906241

PURPOSE: The presence of caregivers or companions during clinical encounters influences the dynamics and outcomes of the encounters. Most prior studies of companions in clinical encounters focus on non-Hispanic White patients. However, there is generally lower-quality patient-physician communication during encounters with Black patients; these communication differences may contribute to racial health disparities. The purpose of the present study was to examine effects of the presence and active participation of companions on encounters between Black patients with cancer and non-Black oncologists. METHODS: This was a secondary analysis of data collected during a larger intervention study. Participants were Black patients with breast, colon, or lung cancer who had a treatment-discussion encounter with a participating non-Black medical oncologist. Video recordings of encounters were coded for patient, companion, and oncologist communication. After the encounter, patients reported perceptions of the recommended treatment; patients and oncologists reported perceptions of each other. RESULTS: Data from 114 patients and 19 oncologists were included in analyses. Only 47% of patients brought a companion to the encounter. Oncologists spent more time with accompanied Black patients, used more patient-centered communication with them, and perceived them as having more social support compared with unaccompanied Black patients. Oncologists reported that accompanied patients asked more questions. When companions participated more actively in the encounter, oncologists used more patient-centered communication. DISCUSSION: Bringing a companion to oncology appointments may be beneficial to Black patients because oncologists spend more time with patients, use more patient-centered communication, and perceive patients more positively, all of which may ultimately improve patient health and well-being outcomes.

IMPORTANCE: Black individuals are underrepresented in cancer clinical trials. OBJECTIVE: To examine whether Black and White men with prostate cancer differ in their willingness to discuss clinical trials with their physicians and, if so, whether patient-level barriers statistically mediate racial differences. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional survey study used baseline data from Partnering Around Cancer Clinical Trials, a randomized clinical trial to increase Black individuals’ enrollment in prostate cancer clinical trials. Data were collected from 2016 through 2019 at 2 National Cancer Institute–designated comprehensive cancer centers; participants were Black and White men with intermediate-risk to high-risk prostate cancer. In mediation analysis, path models regressed willingness onto race and each potential mediator, simultaneously including direct paths from race to each mediator. Significant indirect effect sizes served as evidence for mediation. EXPOSURES: Race was the primary exposure. Potential mediators included age, education, household income, perceived economic burden, pain/physical limitation, health literacy, general trust in physicians, and group-based medical suspicion. MAIN OUTCOMES AND MEASURES: The primary outcome was the answer to a single question: “If you were offered a cancer clinical trial, would you be willing to hear more information about it?” RESULTS: A total of 205 participants were included (92 Black men and 113 White men), with a mean (range) age of 65.7 (45-89) years; 32% had a high school education or lower, and 27.5% had a household income of less than $40 000. Most (88.3%) reported being definitely or probably willing to discuss trials, but White participants were more likely to endorse this highest category of willingness than Black participants (82% vs 64%; χ(2)(2) = 8.81; P = .01). Compared with White participants, Black participants were younger (F(1,182) = 8.67; P

PURPOSE: Cancer clinical trial accrual rates are low, and information about contributing factors is needed. We examined video-recorded clinical interactions to identify circumstances under which patients potentially eligible for a trial at a major cancer center were offered a trial. METHODS: We conducted a qualitative directed content analysis of 62 recorded interactions with physicians (n = 13) and patients with intermediate- or high-risk prostate cancer (n = 43). Patients were screened and potentially eligible for a trial. We observed and coded the interactions in 3 steps: (1) classification of all interactions as explicit offer, offer pending, trial discussed/not offered, or trial not discussed; (2) in interactions with no explicit offer, classification of whether the cancer had progressed; (3) in interactions classified as progression but no trial offered, identification of factors discussed that may explain the lack of an offer. RESULTS: Of the 62 interactions, 29% were classified as explicit offer, 12% as offer pending, 18% as trial discussed/not offered, and 39% as trial not discussed. Of those with no offer, 57% included information that the cancer had not progressed. In 68% of the remaining interactions with patients whose cancer had progressed but did not receive an offer, reasons for the lack of offer were identified, but in 32%, no explanation was provided. CONCLUSION: Even in optimal circumstances, few patients were offered a trial, often because their cancer had not progressed. Findings support professional recommendations to broaden trial inclusion criteria. Findings suggest accrual rates should reflect the proportion of eligible patients who enroll.