The study – the first of its kind in the country – was designed to teach breast cancer patients how to communicate more effectively with their physicians during chemotherapy treatment. A National Cancer Institute grant for $240,000 funded the initial two-year feasibility project, in which 77 percent of patients approached to be in the study agreed to participate.
“During cancer treatment, patients often experience common symptoms of fatigue, pain and depression that can negatively impact their lives,” said principal investigator Doug Post, a family medicine psychologist at Ohio State whose research focuses on interventions to improve communication between patients and physicians.
“Patients often have a hard time communicating their concerns with these symptoms because they don’t want to bother their doctors, so we are trying to improve that patient-doctor communication,” Post said.
Post will present the study’s findings Oct. 5 during the International Conference on Communication in Healthcare in Miami.
In the pilot study, 27 patients were given hand-held mobile devices and training on their use and then were asked to complete weekly assessments that rate pain, fatigue and depression during chemotherapy. They were also encouraged to watch 8- to 12-minute videos on the mobile device the day before each scheduled visit with their physician. The videos teach them how to communicate about symptoms they are having trouble with during treatment. For comparison, a control group of 23 patients experienced conventional care for chemotherapy treatment.
Of the study participants with mobile devices, 83 percent completed the fatigue, pain and depression inventories once a week as instructed. Of those, 65 percent viewed the depression videos and 72 percent the fatigue videos. The pain videos had a viewing rate of 122 percent, meaning that some patients watched the pain videos more than once, said co-investigator Dr. Charles L. Shapiro, director of breast medical oncology at OSUCCC-James.
“Most of the women reported that this tool helped them improve communication with their health care provider, and made them think more about what they were feeling during their treatment,” said Shapiro. “Results of the study suggest that the intervention led to a significant reduction in pain severity.”
Physicians received printouts of patients’ symptoms before office visits.
Videos were tailored to a patient’s race and symptoms. Each video featured physicians and patients explaining how patients can talk to their doctor about pain, depression and fatigue, along with a role-play scene of a physician and patient interacting.
The videos also explain the PACE concept of communication between patients and physician developed by Donald Cegala, professor emeritus in the OSU School of Communication and department of family medicine – Presenting information, Asking questions, Checking understanding and Expressing concerns.
“While patients often think it’s normal to feel fatigue, pain and depression during their treatment, they may not realize that help is available, especially if they don’t share concerns with their physicians,” Post said. “If these quality of life symptoms are not talked about, then they won’t be treated and the patient will likely feel worse.”
Other Ohio State researchers involved in the study include Dr. William Hicks, Dr. Bhuvaneswari Ramaswamy, Cegala, Prabu David, Mira Katz, Ann McAlearney, Electra Paskett and Gary Phillips.
Patient reactions were positive, Post said, as demonstrated by the rates of patient accrual into the randomized controlled trial, patient adherence to protocol instructions, patient completion of the full study protocol and feedback in patient focus groups after completion of the protocol. These findings demonstrate the feasibility of conducting a larger study.
Ohio State cancer investigators are expanding the research to include breast cancer patients in Appalachia Ohio who are being treated at the Holzer Cancer Center in Gallipolis, Ohio. The expanded study, funded by a $244,000 grant from the Lance Armstrong Foundation, will feature 30 breast cancer patients who will view new videos of women and physicians from Appalachia Ohio.
The Ohio State University Comprehensive Cancer Center- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute is one of only 40 Comprehensive Cancer Centers in the United States designated by the National Cancer Institute. Ranked by U.S. News & World Report among the top 20 cancer hospitals in the nation, The James (www.jamesline.com) is the 180-bed adult patient-care component of the cancer program at The Ohio State University. The OSUCCC-James is one of only five centers in the country approved by the NCI to conduct both Phase I and Phase II clinical trials.
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Medical Center Communications