Factors affecting physicians' intentions to communicate personalized prognostic information to cancer patients at the end of life

An experimental vignette study

Paul K J Han, Nathan Dieckmann, Christina Holt, Caitlin Gutheil, Ellen Peters

    Research output: Contribution to journalArticle

    4 Citations (Scopus)

    Abstract

    Purpose. To explore the effects of personalized prognostic information on physicians' intentions to communicate prognosis to cancer patients at the end of life, and to identify factors that moderate these effects. Methods. A factorial experiment was conducted in which 93 family medicine physicians were presented with a hypothetical vignette depicting an end-stage gastric cancer patient seeking prognostic information. Physicians' intentions to communicate prognosis were assessed before and after provision of personalized prognostic information, while emotional distress of the patient and ambiguity (imprecision) of the prognostic estimate were varied between subjects. General linear models were used to test the effects of personalized prognostic information, patient distress, and ambiguity on prognostic communication intentions, and potential moderating effects of 1) perceived patient distress, 2) perceived credibility of prognostic models, 3) physician numeracy (objective and subjective), and 4) physician aversion to risk and ambiguity. Results. Provision of personalized prognostic information increased prognostic communication intentions (P <0.001, η2 = 0.38), although experimentally manipulated patient distress and prognostic ambiguity had no effects. Greater change in communication intentions was positively associated with higher perceived credibility of prognostic models (P = 0.007, η2 = 0.10), higher objective numeracy (P = 0.01, η2 = 0.09), female sex (P = 0.01, η2 = 0.08), and lower perceived patient distress (P = 0.02, η2 = 0.07). Intentions to communicate available personalized prognostic information were positively associated with higher perceived credibility of prognostic models (P = 0.02, η2 = 0.09), higher subjective numeracy (P = 0.02, η2 = 0.08), and lower ambiguity aversion (P = 0.06, η2 = 0.04). Conclusions. Provision of personalized prognostic information increases physicians' prognostic communication intentions to a hypothetical end-stage cancer patient, and situational and physician characteristics moderate this effect. More research is needed to confirm these findings and elucidate the determinants of prognostic communication at the end of life.

    Original languageEnglish (US)
    Pages (from-to)703-713
    Number of pages11
    JournalMedical Decision Making
    Volume36
    Issue number6
    DOIs
    StatePublished - Aug 1 2016

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    Physicians
    Communication
    Neoplasms
    Family Physicians
    Stomach Neoplasms
    Linear Models
    Medicine
    Research

    Keywords

    • affect and emotion
    • numeracy
    • physician-patient communication
    • provider decision making
    • risk communication or risk perception
    • shared decision making

    ASJC Scopus subject areas

    • Health Policy

    Cite this

    Factors affecting physicians' intentions to communicate personalized prognostic information to cancer patients at the end of life : An experimental vignette study. / Han, Paul K J; Dieckmann, Nathan; Holt, Christina; Gutheil, Caitlin; Peters, Ellen.

    In: Medical Decision Making, Vol. 36, No. 6, 01.08.2016, p. 703-713.

    Research output: Contribution to journalArticle

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    abstract = "Purpose. To explore the effects of personalized prognostic information on physicians' intentions to communicate prognosis to cancer patients at the end of life, and to identify factors that moderate these effects. Methods. A factorial experiment was conducted in which 93 family medicine physicians were presented with a hypothetical vignette depicting an end-stage gastric cancer patient seeking prognostic information. Physicians' intentions to communicate prognosis were assessed before and after provision of personalized prognostic information, while emotional distress of the patient and ambiguity (imprecision) of the prognostic estimate were varied between subjects. General linear models were used to test the effects of personalized prognostic information, patient distress, and ambiguity on prognostic communication intentions, and potential moderating effects of 1) perceived patient distress, 2) perceived credibility of prognostic models, 3) physician numeracy (objective and subjective), and 4) physician aversion to risk and ambiguity. Results. Provision of personalized prognostic information increased prognostic communication intentions (P <0.001, η2 = 0.38), although experimentally manipulated patient distress and prognostic ambiguity had no effects. Greater change in communication intentions was positively associated with higher perceived credibility of prognostic models (P = 0.007, η2 = 0.10), higher objective numeracy (P = 0.01, η2 = 0.09), female sex (P = 0.01, η2 = 0.08), and lower perceived patient distress (P = 0.02, η2 = 0.07). Intentions to communicate available personalized prognostic information were positively associated with higher perceived credibility of prognostic models (P = 0.02, η2 = 0.09), higher subjective numeracy (P = 0.02, η2 = 0.08), and lower ambiguity aversion (P = 0.06, η2 = 0.04). Conclusions. Provision of personalized prognostic information increases physicians' prognostic communication intentions to a hypothetical end-stage cancer patient, and situational and physician characteristics moderate this effect. More research is needed to confirm these findings and elucidate the determinants of prognostic communication at the end of life.",
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    AU - Dieckmann, Nathan

    AU - Holt, Christina

    AU - Gutheil, Caitlin

    AU - Peters, Ellen

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    N2 - Purpose. To explore the effects of personalized prognostic information on physicians' intentions to communicate prognosis to cancer patients at the end of life, and to identify factors that moderate these effects. Methods. A factorial experiment was conducted in which 93 family medicine physicians were presented with a hypothetical vignette depicting an end-stage gastric cancer patient seeking prognostic information. Physicians' intentions to communicate prognosis were assessed before and after provision of personalized prognostic information, while emotional distress of the patient and ambiguity (imprecision) of the prognostic estimate were varied between subjects. General linear models were used to test the effects of personalized prognostic information, patient distress, and ambiguity on prognostic communication intentions, and potential moderating effects of 1) perceived patient distress, 2) perceived credibility of prognostic models, 3) physician numeracy (objective and subjective), and 4) physician aversion to risk and ambiguity. Results. Provision of personalized prognostic information increased prognostic communication intentions (P <0.001, η2 = 0.38), although experimentally manipulated patient distress and prognostic ambiguity had no effects. Greater change in communication intentions was positively associated with higher perceived credibility of prognostic models (P = 0.007, η2 = 0.10), higher objective numeracy (P = 0.01, η2 = 0.09), female sex (P = 0.01, η2 = 0.08), and lower perceived patient distress (P = 0.02, η2 = 0.07). Intentions to communicate available personalized prognostic information were positively associated with higher perceived credibility of prognostic models (P = 0.02, η2 = 0.09), higher subjective numeracy (P = 0.02, η2 = 0.08), and lower ambiguity aversion (P = 0.06, η2 = 0.04). Conclusions. Provision of personalized prognostic information increases physicians' prognostic communication intentions to a hypothetical end-stage cancer patient, and situational and physician characteristics moderate this effect. More research is needed to confirm these findings and elucidate the determinants of prognostic communication at the end of life.

    AB - Purpose. To explore the effects of personalized prognostic information on physicians' intentions to communicate prognosis to cancer patients at the end of life, and to identify factors that moderate these effects. Methods. A factorial experiment was conducted in which 93 family medicine physicians were presented with a hypothetical vignette depicting an end-stage gastric cancer patient seeking prognostic information. Physicians' intentions to communicate prognosis were assessed before and after provision of personalized prognostic information, while emotional distress of the patient and ambiguity (imprecision) of the prognostic estimate were varied between subjects. General linear models were used to test the effects of personalized prognostic information, patient distress, and ambiguity on prognostic communication intentions, and potential moderating effects of 1) perceived patient distress, 2) perceived credibility of prognostic models, 3) physician numeracy (objective and subjective), and 4) physician aversion to risk and ambiguity. Results. Provision of personalized prognostic information increased prognostic communication intentions (P <0.001, η2 = 0.38), although experimentally manipulated patient distress and prognostic ambiguity had no effects. Greater change in communication intentions was positively associated with higher perceived credibility of prognostic models (P = 0.007, η2 = 0.10), higher objective numeracy (P = 0.01, η2 = 0.09), female sex (P = 0.01, η2 = 0.08), and lower perceived patient distress (P = 0.02, η2 = 0.07). Intentions to communicate available personalized prognostic information were positively associated with higher perceived credibility of prognostic models (P = 0.02, η2 = 0.09), higher subjective numeracy (P = 0.02, η2 = 0.08), and lower ambiguity aversion (P = 0.06, η2 = 0.04). Conclusions. Provision of personalized prognostic information increases physicians' prognostic communication intentions to a hypothetical end-stage cancer patient, and situational and physician characteristics moderate this effect. More research is needed to confirm these findings and elucidate the determinants of prognostic communication at the end of life.

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    KW - numeracy

    KW - physician-patient communication

    KW - provider decision making

    KW - risk communication or risk perception

    KW - shared decision making

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