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Disclosing a Diagnosis of Cancer: Considerations Specific to Gynecologic Oncology Patients

Kuroki, Lindsay M. MD; Zhao, Qiuhong MS; Jeffe, Donna B. PhD; Powell, Matthew A. MD; Hagemann, Andrea R. MD; Thaker, Premal H. MD, MS; Massad, L. Stewart MD; Mutch, David G. MD; Zighelboim, Israel MD

doi: 10.1097/AOG.0b013e3182a9bf42
Original Research

OBJECTIVE: To characterize gynecologic oncology patients' perceptions of the process of disclosure of a cancer diagnosis.

METHODS: We surveyed 100 gynecologic oncology patients between December 2011 and September 2012. An 83-item tool based on three validated assessment tools evaluated patient-centered factors, physician behavior and communication skills, and environmental factors. Associations between patients' satisfaction and these variables were analyzed using Wilcoxon rank-sum, Kruskal-Wallis, and Spearman's rho tests. Poisson regression was used to assess factors associated with patient's satisfaction.

RESULTS: Twenty-four percent of patients were notified of their diagnosis by phone, 60% in the physician's office, and 16% in the hospital. Disclosure was performed by an obstetrician–gynecologist (58%), gynecologic oncologist (26%), primary care physician (8%), or other (8%). Fifty-two percent of all patients were accompanied by a support person. Higher patient satisfaction scores were associated with face-to-face disclosure (mean score 91% compared with over the phone 72%, P=.02), a private setting (mean score 92% compared with impersonal setting 72%, P=.004), and duration of the encounter of greater than 10 minutes (mean score 94% compared with less than 10 minutes 79%, P<.001). Multivariate analysis confirmed that both physician communication skills (P<.001) and patient-centered factors (eg, perception of physician sensitivity and empathy, opportunities to ask questions and express emotion, and set the pace of conversation; P=.013) were associated with higher patient satisfaction.

CONCLUSIONS: Effective physician communication skills and patient-centered factors resulted in higher patient satisfaction with the gynecologic cancer diagnosis disclosure experience.

LEVEL OF EVIDENCE: II

Effective physician communication skills and patient-centered factors are associated with increased patient satisfaction at the time of disclosure of a gynecologic cancer diagnosis.

Division of Gynecologic Oncology and the Division of Clinical Research, Department of Obstetrics and Gynecology, and the Division of Health Behavior Research, Department of Medicine, Washington University School of Medicine, and the Alvin J. Siteman Cancer Center, St. Louis, Missouri.

Dr. Zighelboim’s current affiliation: St. Luke's Cancer Care Associates, Temple University School of Medicine, Bethlehem, Pennsylvania.

Corresponding author: Lindsay M. Kuroki, MD, Department of Obstetrics & Gynecology, 4911 Barnes Jewish Hospital Plaza, Box 8064, St Louis, MO 63110; e-mail: kurokil@wudosis.wustl.edu.

The authors thank the Health Behavior, Communication and Outreach Core for protocol and questionnaire development services. The Core is supported in part by the National Cancer Institute Cancer Center Support Grant (P30 CA091842) to the Alvin J. Siteman Cancer Center at Barnes Jewish Hospital and Washington University School of Medicine in St Louis, Missouri.

The Siteman Cancer Center is supported by National Cancer Institute Cancer Center Support Grant P30 CA91842.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2013 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.