Original ArticleA Survey of Expectations and Understanding of Palliative Radiotherapy from Patients with Advanced Cancer
Introduction
Patient satisfaction is an integral component of quality of care, and is derived from the congruence between patients’ and their healthcare teams’ expectations of consultation and treatment [1], [2], [3]. A large proportion of cancer patients do not have a clear understanding of their disease prognosis [3], [4] or treatment [2], [3]. A survey conducted in 2001 revealed that 35% of patients with symptomatic metastases referred for a palliative radiotherapy consultation did not have a clear understanding of their illness and believed their cancer was curable. Furthermore, 20% expected palliative radiotherapy would cure their advanced cancer, and 38% believed treatment would prolong their lives, thus, rendering their expectations to be unrealistic [1].
Patient dissatisfaction or misunderstanding may influence patients’ preferences for treatment and potentially have a negative effect on quality of life [4], [5]. Patient dissatisfaction has been linked with non-compliance with medical advice, poorer coping [6] and pursuing more aggressive and potentially harmful treatment regimens [5].
To determine if patient expectations and understanding of their advanced cancer and radiotherapy treatment have changed over the past decade, a prospective patient-administered questionnaire was repeated both before and after consultation with the Rapid Response Radiotherapy Program (RRRP). The primary objective was to assess patients’ understanding of their illness and expectations of palliative radiotherapy to treat symptomatic metastases both before and after consultation with the RRRP. The secondary objective was to explore the relationship between response and demographics/Edmonton Symptom Assessment Scale (ESAS) scores.
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Materials and Methods
After receiving the institution’s research ethics board approval, patients referred for palliative radiotherapy at the RRRP were prospectively asked to complete a survey consisting of 11 questions before and after consultation with their radiation oncologist. The survey items included the patient’s understanding of their illness, radiotherapy treatment, its aims and satisfaction with the information they were given before and after the radiation consultation. The following demographic
Results
Seventy-seven physicians referred 100 patients to the RRRP for a palliative radiotherapy consultation from March to October 2009. The median age was 66 years (range: 38–93). Fifty-six were men and 44 were women. The median KPS and current pain score for these patients were 70 (30–100) and 3 (0–10), respectively. Most patients had a primary cancer diagnosis of lung (38%), prostate (19%) or breast (17%). Concurrent chemotherapy, hormone therapy or any other concurrent therapy involved 15, seven
Discussion
This is the first study to document the change in patients’ understanding and expectations of their cancer and radiation before and after consultation with the physician and healthcare team in an outpatient palliative radiation clinic setting. A successful patient–doctor consultation is contingent on patient satisfaction [7]. Over the past decade, up to 35% of patients who present with advanced cancer continue to believe their illness is curable, and our prospective cohort was no exception [1],
Conflict of Interest
There are no conflicts of interest to declare with this manuscript.
Acknowledgements
We thank the Michael and Karyn Goldstein Cancer Research Fund, Dr A. Swaminath, R. Presutti, J. Nguyen, S. Culleton, L. Zeng and Stacy Yuen for assistance.
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