Knowledge power. Want to improve the effectiveness of cancer medicine? Take time to educate the patient

Author: David Rumbach

Not all improvements in chemotherapy come from test tubes in the labs of pharmaceutical companies.p. A recent study by University of Notre Dame researchers suggests patient education might also be a key ingredient in successful medical treatment of cancer.p. Their study, which involved nearly 250 local patients, found that people benefited from having a full understanding of what lay in store for them before they began their battle with cancer.p. That knowledge included some potentially harsh doses of reality, including their chances of survival with and without treatment, how chemotherapy would make them feel and how both their illness and their medicine were likely to change their finances and their lives.p. Dr. Rudolph Navari, director of ND’s Walther Cancer Research Center, said the study compared 239 patients who went to see four local cancer specialists after being diagnosed with a malignancy.p. The patients ranged in age from 27 to 85, with the average age being about 63. They were about evenly split between men and women.p. Some of the patients received extra education to help them understand their situation while others did not, said Navari, who is also a practicing oncologist in South Bend.p. Those chosen, at random, for the "educational intervention’’ were given a prompt sheet listing nine suggested questions for them to ask the oncologist.p. They also were shown a 35-minute video depicting five different vignettes of patient-doctor interaction.p. The researchers wanted to see if the education would improve the course of treatment, Navari said.p. And they found that it did. A big improvement.p. Knowledge is power
Patients who received the educational intervention were more likely to complete their course of chemotherapy rather than giving up and quitting early. And they were less likely to experience serious side effects.p. One possible explanation: Expecting hardship makes it easier to endure.p. "If you know you’re going to lose your hair, if you understand that’s going to happen, you’re less likely to stop treatment,‘’ Navari said.p. Among breast cancer patients, 86 percent of those who received the extra education had either completed their treatment or were still on course after six months. That compares with only 63 percent of those who do not receive the educational intervention.p. Similarly, 78 percent of colon cancer patients who received extra education completed their treatment, compared with 59 percent for those who didn’t.p. The results for toxicity were also impressive. Thirty percent of breast cancer patients in the non-intervention group reported having serious toxic side effects, compared with only 12 percent of those who did receive intervention.p. Besides having the advantage of being forewarned, Navari said, people who received the added education may have chosen treatments that were less toxic and more compatible with their lifestyles than they otherwise might have.p. The study found that most patients didn’t truly understand their cancer diagnosis after it was first given to them by their primary care doctor or surgeon, even though modern practice calls for full disclosure by the diagnosing physician.p. That may be because of shortcomings in doctors’ communication skills.p. Or, the study suggests, it may be because patients, having just gotten some very bad news, are still too anxious to comprehend what they’re told about their condition. They may be in a state of denial.p. "Once they hear the word ‘cancer,’ they may not hear much else, even if the doctor goes on to give them a lengthy, detailed explanation,‘’ Navari said.p. Benefits of question-asking
The study suggests patients learn more if they go into their meeting with the oncologist armed with a set of questions.p. The "question-asking’’ technique, through the use of a prompt sheet of suggested queries, may have helped patients participate more actively in the treatment decision, Navari said, even though they may still wind up simply asking the doctors what to do.p. "It’s a two-way thing,‘’ he said. "Often after a lot of questions, the person will just ask the doctor, ’What would you do if it were you, or your loved one?’ ‘’p. Navari said the researchers will continue to follow patients included in the study group to see if the educational intervention has an even bigger impact: allowing cancer patients to live longer.p. Navari said the study’s findings also highlight the importance of doctors having good communications skills, what people often refer to as having a good "bedside manner.‘’ The National Board of Medical Examiners recently announced that, starting next year, medical students will have to pass a live-action exam of their communications skills before they are certified as doctors.p. "Having a good bedside manner is simply communicating information patients need to know in a way that indicates you care about them,’’ he said. "The more patients know about what they have, the better off they are. It’s all tied together.’’

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