Effective patient-clinician communication (PCC) is central to the delivery of high-quality care, according to the National Cancer Institute (NCI), and it becomes even more crucial in the cancer setting where patients deal with stress, uncertainty, complex information, and life-altering medical decisions. “PCC occurs when clinicians respond to patients’ needs, preferences, concerns, and emotions,” explains Rachel A. Pozzar, PhD, RN, FNR-BC, a postdoctoral research fellow at the Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, and lead author of a study recently presented at the virtual 2021 ASCO Annual Meeting. “Although the NCI Framework for PCC in Cancer Care highlights the potential of PCC to improve health-related quality of life (HRQOL), to date, few studies have empirically examined associations between PCC and HRQOL in patients with ovarian cancer, according to Dr. Pozzar and colleagues.
Greater Perceived PCC Linked with Better Overall HRQOL
To address this information gap, the study team sought to assess links between perceived PCC and HRQOL. The researchers conducted a cross-sectional, descriptive survey of English-speaking adults with ovarian cancer recruited both online and from an NCI-designated cancer center. They assessed perceived PCC with Patient-Centered Communication in Cancer Care (PCC-Ca)-36 and HRQOL with the Functional Assessment of Cancer Therapy: General (FACT-G). Simple linear regression was used to identify univariate associations between participant characteristics, PCC-CA-36 total, FACT-G total, and FACT-G subscale (physical, social and family, emotional, and functional well-being) scores.
A total of 176 participants completed the survey. “In multivariable analyses, older age, working (vs not working, no current treatment (vs any current treatment), and greater perceived PCC were associated with better overall HRQOL,” the study authors write. They also found:
- Working and no current treatment were linked with better physical well-being.
- Older age, not being cared for by a gynecologic oncologist (vs being care for by one), and greater perceive PCC were associated with better social and family well-being.
- Older age, being recruited online (vs in clinic), and greater perceived PCC were associated with better emotional well-being.
- Older age, working, rural residence (vs not), no current treatment, and greater perceived PCC were associated with better functional well-being.
Strengthening the Therapeutic Alliance
“Overall, we found that greater perceived PCC was significantly associated with better overall HRQOL and better social, emotional, and functional well being in patients with ovarian cancer,” the study authors conclude. “The NCI Framework for PCC in Cancer Care posits that PCC prompts HRQOL by strengthening the therapeutic alliance, enhancing social support, and improving patient knowledge.”
PCC is especially important for patients with ovarian cancer, Dr. Pozzar notes, since this type of cancer is the fifth leading cause of all caner deaths in women in the United States. “Furthermore, more than 65% of ovarian cancer cases are diagnosed at an advanced stage. Not only is there a tremendous physical toll on patients with ovarian cancer, but a psychological one as well. About one-fifth of patients with ovarian cancer develop moderate to severe psychological distress.”
Dr. Pozzar and colleagues state that they would like to see future studies identify mediators of associations between PCC and HRQOL, examine inter-individual variability in characteristics that may compromise HRQOL, and study associations between PCC and HRQOL over time. “We are especially interested in follow up interviews with patients about how their interactions with clinicians affected them,” she says. “As clinicians, our interactions with patients have the potential to help improve their QOL.”