Journal Article

Gaps in patient-physician communication at the time of malignant bowel obstruction from recurrent gynecologic cancer: a qualitative study

Chor, Julie, Hlubocky, Fay J., Yamada, S. Diane, Hoppenot, Claire, Lee, Nita K.

2022

Overview

Purpose We sought to investigate the patient and physician approaches to malignant bowel obstruction (MBO) due to recurrent gynecologic cancer by (1) comparing patient and physician expectations and priorities during a new MBO diagnosis, and (2) highlighting factors that facilitate patient-doctor communication. Methods Patients were interviewed about their experience during an admission for MBO, and physicians were interviewed about their general approach towards MBO. Interviews were analyzed for themes using QDAMiner qualitative analysis software. The analysis utilized the framework analysis and used both predetermined themes and those that emerged from the data. Results We interviewed 14 patients admitted with MBO from recurrent gynecologic cancer and 15 gynecologic oncologists. We found differences between patients and physicians regarding plans for next chemotherapy treatments, foremost priorities, communication styles, and need for end-of-life discussions. Both patients and physicians felt that patient-physician communication was improved in situations of trust, understanding patient preferences, corroboration of information, and increased time spent with patients during and before the MBO. Conclusion Gaps in patient-physician communication could be targeted to improve the patient experience and physician counseling during a difficult diagnosis. Our findings emphasize a need for patient-physician discussions to focus on expectations for future cancer-directed treatments, support for patients at home with home health or hospice level support in line with their wishes, and acknowledgement of uncertainty while providing direct information about the MBO diagnosis.

• Publisher: Springer Berlin Heidelberg,Springer,Springer Nature B.V
• Subject: Cancer / Chemotherapy / Communication / Corroboration / Diseases / End of life decisions / Expectations / Female / Genital Neoplasms, Female - complications / Gynecological cancer / Hospice care / Humans / Interpersonal communication / Intestinal obstruction / Intestinal Obstruction - etiology / Intestinal Obstruction - therapy / Malignant / Management buyouts / Medical diagnosis / Medicine / Medicine & Public Health / Nursing / Nursing Research / Obstruction / Oncologists / Oncology / Oncology, Experimental / Original Article / Pain Medicine / Palliative Care / Patient admissions / Patient communication / Patients / Physician-Patient Relations / Physicians / Practitioner patient relationship / Qualitative research / Recurrent / Rehabilitation Medicine / Relapse / Treatment methods / Treatment preferences / Uncertainty