How do doctors and patients talk about QoL data in consultations?

Abstract

AIMS: To explore in detail how oncologists refer to and use QoL information during consultations and how this does or does not provide patients with opportunities to become involved in decision making. Findings will inform the development of a program to train doctors in the use of QoL data. METHODS: We purposively selected 22 tape recorded consultations in which doctors explicitly referred to QoL data from the intervention arm of a previous trial A-17 (Velikova et al, 2004). In this arm, patients completed the EORTCQLQC- 30 and the Hospital Anxiety and Depression Scale(HADS)and this was fed back to the doctor prior to the consultation. Consultations were transcribed and analysed using conversation analysis to identify patterns in when and how doctors referred to the QoL data, whether this led to the patient elaborating on their problems and how treatment decisions were then made. RESULTS: The QoL data was introduced into the consultation by doctors either to confirm and validate QoL problems in response to issues that patients themselves raised or to initiate discussion about a new topic area. Sometimes reference to the QoL data was integrated into the doctor_s questions about side effects but other times it was an _add on_ after these issues had been discussed. Using the data to focus on a specific QoL issue was more likely to lead to the patient elaborating on their problems than when doctors made a general reference to the QoL data. The QoL data was rarely referred to in making decisions about chemotherapy but was referred to in decisions to treat side effects such as constipation, pain and nausea. In these instances, doctors referred to the QoL data as an _external authority_ to justify advice and treatment decisions, rather than determine these decisions. CONCLUSIONS: These patterns suggest that training programs should focus on helping doctors to integrate the QoL data into their questioning about side effects and to use QoL data to ask about specific problems, rather than QoL in general