Communication about treatment options in early stage breast cancer can be difficult. Decisions about the need for chemotherapy have to take account of the likely benefits in terms of preventing a recurrence versus the treatment related side effects. Expressing risk is often confusing, percentages puzzle many people and verbal descriptors, such as 'common' and 'rare', produce widely differing estimates. In the past few years, genomic profiling tests (e.g. Oncotype DX) can provide recurrence scores, which together with other characteristics help determine the likely benefit of chemotherapy for an individual patient.
However, would a woman who has high anxiety in a consultation with a cautious oncologist, heed a test result suggesting that her recurrence risk score was low/borderline? Often anxious patients are uncomfortable with ambiguity and oncologists themselves may have communication styles that convey their own uncertainty or conversely over-optimism.
In order to help both patients and clinicians we developed an educational program comprising a set of filmed scenarios of doctors talking to patients with different characteristics and risk test results. The scenarios provide opportunities for participants to consider the communication challenges with the different types of patients. The materials were produced as part of last year's Breast Cancer Research Foundation grant. We now wish to determine the impact of the materials on doctors' communication about risk before providing the materials freely to facilitators and educational organisations.
During workshops, participants are encouraged to consider how they structure test result discussions with patients; explain risk and check patients' understanding of this. To evaluate efficacy we will audiotape clinicians discussing genomic test results with a simulated patient (actor) before and after the workshops. Their communication skills will be assessed subjectively (clinician self-assessment) and objectively by the actor patient and two independent researchers. The tapes and code for the presence/absence of certain key points, e.g. checking patient understanding, will be studied. The researchers undertaking the coding will not be aware if the taped recording is before or after the course.