Patients With Cancer Appreciate Undivided Attention From Doctors

Beth Fand Incollingo

Doctors need to keep careful notes, but they shouldn’t allow that process to compromise their connection with patients.

That was the finding of a recent study testing whether the computers that many oncologists use to take notes during appointments could be detracting from their relationships with those they treat.

Specifically, the study demonstrated that patients with advanced cancer prefer that their physicians speak with them while holding a note pad, rather than while typing into computers that link to electronic health records.

The findings were presented Oct. 23 during a presscast in advance of the 2017 Palliative and Supportive Care in Oncology Symposium, which will be held Oct. 27 and 28 in San Diego.

“We know that having a good rapport with patients can be extremely beneficial for their health,” said Ali Haider, M.D., the study’s lead author and an assistant professor at the University of Texas MD Anderson Cancer Center in the Department of Palliative, Rehabilitation, and Integrative Medicine. “Patients with advanced disease need the cues that come with direct interaction to help them along with their care.”

The study was the first to compare exam-room interactions between patients with advanced cancer and their doctors, with and without computer use. The researchers embarked on the study because they were concerned that computer use might interfere with these interactions, and because previous research supported the idea that “people with chronic health concerns, and often accompanying emotional issues, want their doctors to talk to them directly,” according to a press release issued by the American Society for Clinical Oncology (ASCO) in conjunction with the presscast.

A main reason for a rise in computer use by physicians in the exam room is that, as of 2016, nine in 10 physicians’ offices had implemented electronic health records, Haider said. Since 2008, he said, the rate of adoption of these systems has tripled.

In the study, 120 people being treated at an outpatient clinic for localized, recurrent or metastatic cancer were randomized into four groups of equal size. Each group watched a two-minute video of actors playing out a scripted doctor-patient exam-room visit. Two groups watched a video in which the doctor typed into a computer while speaking with the patient, and the other two groups saw a video in which the doctor instead took notes using a note pad. Gestures and all other nonverbal communication were standardized in the videos to minimize bias.

The patients didn’t know the purpose of the study.

After watching a first video, patients filled out a questionnaire in which they rated the doctor’s communication skills, compassion and professionalism.

Then, each group watched a video that featured different actors and a different note-taking method — whichever of the two options the groups had not previously observed. Once again, the study participants followed up after the video by filling out a questionnaire and, additionally, by expressing their physician preference.

After watching their first videos, participants perceived doctors who spoke with patients face-to-face as being more compassionate and professional, and as having better communication skills, than physicians who used computers. After watching second videos, 72 percent of participants said they favored face-to-face interaction. Patients rated the doctors who used note pads as even more compassionate after having watched both videos, Haider said.

The upshot? “Better communication can enhance patient trust and satisfaction,” he said.

Haider noted that the study explored patient perceptions, but not strategies for better integrating computer use into exam-room visits.

Its authors wrote that the study results may be less relevant in hospital settings, where visits are likely more “frequent and vigorous.” They postulated that the findings would apply to patients with early-stage cancers, but not necessarily to younger populations with higher computer literacy.

Another potential area of future study is whether other electronic devices, such as tablets or iPads, are perceived by patients to be as intrusive as computers during exam-room visits with doctors, Haider said
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