Clear communication is an essential component of patient-centered care and improved outcomes in cancer. To foster dialogue with patients, a common strategy has been to use electronic health records (EHRs) with exam room computers (ERCs). “Studies have shown that EHRs can be a burden to doctors and contributes to physician burnout,” says Eduardo Bruera, MD. “However, few analyses have explored the impact of EHRs on patients.”

 

Analyzing the Effect

ERCs may be helpful for constructing talking points, but little is known about how patients perceive their physicians when these tools are relied upon during patient encounters. A research letter published in JAMA Oncology by Dr. Bruera and colleagues compared patients’ perceptions of physicians’ compassion after watching two standardized scripted-video vignettes of physicians. The first vignette portrayed a face-to-face (F2F) clinic visit while the second portrayed a physician using an ERC. The study also compared patients’ perception of physicians’ communication skills and professionalism and patients’ overall physician preferences with F2F and ERC clinic visits.

For the study, patients were recruited from a palliative care clinic if they spoke English, were 18 years of age or older, and had advanced cancer. About 90% of patients seen in the palliative care clinic had advanced cancer with a median survival of 8 months. All participants were treated by a multidisciplinary palliative care team.

According to findings, patients randomized to the F2F group gave physicians higher scores on compassion, communication skills, and professionalism than the ERC group after watching and assessing the video vignettes (Table). The majority of patients in the study—71%—preferred the F2F encounters to the ERC visits. “Patients perceived physicians as being more compassionate and professional when they don’t use EHRs during medical encounters,” says Dr. Bruera. The results highlight the importance of conducting F2F visits with patients when treating cancer. While using computers can guide conversations with patients, this approach may have a negative impact on how patients view their healthcare providers.

 

Assessing the Implications

The study authors noted that one explanation for the findings is that patients might value undivided attention from their healthcare providers and perceive those who engage in ERC to be more distracted during visits. It is also possible that patients’ perceptions might reflect physicians’ behaviors rather than the presence of the ERC. “Regardless of the cause, it’s clear that EHRs need to become easier to use,” Dr. Bruera says. “Current EHR programs are rudimentary and require too much attention from physicians. When EHR use is unavoidable, physicians should explain the reasons why they are relying on the machine in an effort to ease patient concerns.”

As technology continues to evolve and is increasingly permeating the healthcare system, it is important to continue investigating the impact of tools like ERCs and EHRs on patient perceptions. Additional studies that focus on strategies to mitigate the negative effects of ERC use on physician-patient communication are also needed.

“Future research should focus on strategies to minimize the negative impact of EHRs on the patient experience in the consultation room,” says Dr. Bruera. “This might include voice recognition programs or ensuring that screens are positioned in ways that will not obstruct the patient-physician interaction. It’s also important to determine educate patients on why EHRs are being used as a tool in cancer care. Conveying this information to patients may help them feel reassured that they are the center of attention—rather than the machine—during encounters. In the meantime, it’s important for clinicians to make a concerted effort to minimize use of EHRs during medical encounters and reassure patients that they are the focus of their physician’s attention.”

References

Haider A, Tanco K, Epner M, et al. Physicians’ compassion, communication skills, and professionalism with and without physicians’ use of an examination room computer: a randomized clinical trial. JAMA Oncol. 2018;4:879-881. Available at: https://jamanetwork.com/journals/jamaoncology/article-abstract/2678462.

Tanco K, Rhondali W, Perez-Cruz P, et al. Patient perception of physician compassion after a more optimistic vs a less optimistic message: a randomized clinical trial. JAMA Oncol. 2015;1:176-183.

Fogarty LA, Curbow BA, Wingard JR, McDonnell K, Somerfield MR. Can 40 seconds of compassion reduce patient anxiety? J Clin Oncol. 1999;17:371-379.

van Vliet LM, Hillen MA, van der Wall E, Plum N, Bensing JM. How to create and administer scripted video-vignettes in an experimental study on disclosure of a palliative breast cancer diagnosis. Patient Educ Couns. 2013;91:56-64.

Hillen MA, van Vliet LM, de Haes HC, Smets EM. Developing and administering scripted video vignettes for experimental research of patient-provider communication. Patient Educ Couns. 2013;91:295-309.