Elsevier

European Journal of Cancer

Volume 46, Issue 18, December 2010, Pages 3192-3199
European Journal of Cancer

Optimising methods for communicating survival data to patients undergoing cancer surgery

https://doi.org/10.1016/j.ejca.2010.07.030Get rights and content

Abstract

Background

Patients undergoing cancer surgery require outcome data to inform decisions, but communication of numerical risk is difficult. This study assessed patient understanding of survival data presented in different formats.

Methods

Semi-structured interviews in which patients interpreted four presentation formats of survival data (three graphical and one narrative) were audio-recorded. The interviewer and a blinded observer (listening to the audio-recordings) scored patients’ understanding of each format. Logistic regression examined associations between understanding and clinical and socio-demographic details.

Results

Seventy participants with colorectal cancer were interviewed and 67 [95.7%, 95% confidence intervals (CIs) 90.9–100%] correctly interpreted a simplified Kaplan–Meier survival curve. A high proportion accurately understood data presented as a bar chart or pictograph (94.3%, 95% CIs 88.7–99.9% and 92.9%, 95% CIs 86.7–99.0% respectively). Standard narrative alone was least well understood (n = 53, 75.7%, 95% CIs 65.4–86.0%). Multivariable analyses demonstrated that older and female patients had poorer overall understanding (OR 0.93 per year, 95% CIs 0.87–0.98, p = 0.01 and OR 0.24, 95% CIs 0.07–0.86, p = 0.03).

Conclusion

Patient understanding of survival data was higher when presented with graphs compared to narrative alone. Further work examining understanding in the clinical context and before surgery is recommended before this can be used routinely.

Introduction

Informing patients of the potential advantages of cancer surgery primarily includes communication of expected survival benefits synthesised from available evidence. It is necessary to effectively explain operative risks and to describe the longer term consequences of surgery on patient’s health. In most healthcare settings this is the responsibility of the operating surgeon. Ensuring that information is understandable and relevant will also meet patients’ information needs and the standards required for informed consent for surgery.1, 2, 3

Communicating survival information effectively is complex because of the sensitive nature of the information and the potential problems with misunderstanding numerical concepts. Recent work has shown that after cancer surgery patients prefer surgeons to initiate these discussions and that most patients want to discuss this type of sensitive data.4, 5, 6, 7 Options to improve patient understanding of survival data are to supplement traditional narrative consultations with graphs in a simple clear format or to use pictographs illustrating proportions of alive patients.5, 8 The aim of this study was to examine patient understanding of different graphical presentation types of survival data or information expressed as narrative alone and to investigate whether understanding was influenced by clinical and socio-demographic variables.

Section snippets

Materials and methods

Patients were identified from the colorectal multi-disciplinary cancer team records at University Hospitals Bristol NHS Foundation Trust. Eligible for the study were those with carcinoma of the colon, rectum or anus that had completed, were undergoing or awaiting potentially curative treatment, including surgery, surgery and adjuvant chemotherapy or pre-operative radiotherapy. Patients were excluded if there was evidence of concurrent malignancy or if they could not speak and understand

Results

Seventy patients participated (42 male, 60%) of which the majority (n = 66, 94%) were interviewed in their homes. Socio-demographic and clinical data are presented (Table 1). Most participants correctly interpreted each presentation style, with understanding ranging from 96% (n = 67) for the simplified Kaplan–Meier curve to 76% (n = 53) for the narrative alone (Table 2). Indeed, examination of the 95% confidence intervals suggests that understanding of the narrative alone was dramatically poorer than

Discussion

This study has demonstrated that most patients correctly understand prognostic data when presented graphically. The traditional narrative alone was least well understood, especially by women, although 61% of women and 86% of men accurately interpreted the written text. Multivariable analyses adjusting for potential confounding factors suggested that increasing age was associated with poorer understanding of all formats. It is recommended, based on these data, that graphical information is used

Sources of funding

University of Bristol Cancer Research Fund; A.G.K.M. is funded by a fellowship from the Royal College of Surgeons of England.

Conflict of interest statement

None declared.

Acknowledgments

We would like to acknowledge the consultants responsible for the clinical care of the patients in this study: Mr. Paul Durdey, Mr. Paul Sylvester and Mr. Rob Longman. This study was supported by the University of Bristol Cancer Research Fund. A.G.K.M. is funded by a fellowship from the Royal College of Surgeons of England.

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  • Cited by (0)

    Conference presentations: National Cancer Research Institute Conference (October 2009, Birmingham, UK); Association of Surgeons of Great Britain and Ireland Annual Congress (April 2010, Liverpool, UK).

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