Characterizing patient-oncologist communication in genomic tumor testing: The 21-gene recurrence score as an exemplar.
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OBJECTIVE: Women with early-stage, ER + breast cancer are recommend to receive genomic profiling tests, such as the 21-gene Recurrence Score (RS) test, to guide treatment decisions. We examined test- and treatment-related information discussed and the associations between RS categories and aspects of communication during patient-oncologist clinical encounters. METHODS: As part of a larger trial, clinical encounters (N = 46) were audiorecorded and coded for 1) RS- and treatment-related information, 2) shared decision making, 3) patient active participation, and 4) oncologist patient-centered communication. We examined differences by RS category using mixed models, adjusting for nesting within oncologist. RESULTS: Patients with a high RS were more likely to receive a chemotherapy recommendation (p < .01), hear about the risks/side effects of chemotherapy (p < .01), and offer their preferences (p = .02) than those with intermediate or low RS. Elements of shared decision making increased with RS. Oncologist patient-centered communication (M = 4.09/5, SD = .25) and patient active participation (M = 3.5/4, SD = 1.0) were high across RS. CONCLUSION: Findings suggest that disease severity, rather than clinical uncertainty, impact treatment recommendations and shared decision making. PRACTICE IMPLICATIONS: Oncologists adjust test- and treatment-related information and shared decision making by disease severity. This information provides a framework to inform decision making in complex cancer and genomics settings.
author list (cited authors)
O'Neill, S. C., Vadaparampil, S. T., Street, R. L., Moore, T. F., Isaacs, C., Han, H. S., ... Eggly, S.
complete list of authors
O'Neill, Suzanne C||Vadaparampil, Susan T||Street, Richard L||Moore, Tanina Foster||Isaacs, Claudine||Han, Hyo S||Augusto, Bianca||Garcia, Jennifer||Lopez, Katherine||Brilleman, Matilda||Jayasekera, Jinani||Eggly, Susan