DO PHYSICIANS NEED HELP TO ADEQUATELY INFORM AND SUPPORT PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA? RESULTS FROM A QUALITATIVE STUDY IN GREECE
Author(s): ,
Christina Karamanidou
Affiliations:
Institute of Applied Biosciences,CERTH,Thessaloniki,Greece
,
Aliki Xochelli
Affiliations:
Institute of Applied Biosciences,CERTH,Thessaloniki,Greece
,
Vassilis Koutkias
Affiliations:
Institute of Applied Biosciences,CERTH,Thessaloniki,Greece
,
Paolo Ghia
Affiliations:
Division of Experimental Oncology and Department of Onco-Hematology,Università Vita-Salute San Raffaele and IRCCS San Raffaele Scientific Institute,Milan,Italy
Kostas Stamatopoulos
Affiliations:
Institute of Applied Biosciences,CERTH,Thessaloniki,Greece
EHA Library. XOCHELLI A. 06/23/17; 181665; P378
Aliki XOCHELLI
Aliki XOCHELLI
Contributions
Abstract

Abstract: P378

Type: Poster Presentation

Presentation during EHA22: On Friday, June 23, 2017 from 17:15 - 18:45

Location: Poster area (Hall 7)

Background
Despite recent progress in prognostication and management, chronic lymphocytic leukemia (CLL) remains unpredictable at diagnosis, while virtually incurable, posing challenges to physicians on how to properly communicate the actual nature of the disease. Moreover, the great majority (~85%) of patients do not need treatment at diagnosis, creating a major cognitive dissonance between the perception of leukemia diagnosis and the “wait & watch” strategy usually applied, that may become a major reason of anxiety and quality of life (QoL) impairment for patients and frustration for physicians. Evidently, both patients and physicians need parameters that would allow co-decision making tailored to each particular case.

Aims
To identify physicians’ needs in order to improve their communication skills and thus facilitate CLL patient empowerment through a patient-centeredness model.

Methods
An in-depth qualitative study with semi-structured interviews was conducted within hematologists (n=30) all over Greece. Data collection was considered as completed when saturation was reached i.e. no new themes emerged as assessed by the investigators. Content analysis was performed separately by a hematologist and a health psychologist with 98% inter-rater reliability score.

Results
None of the participants had ever received formal communication training but rather adopted the techniques of senior physicians or developed their own through experience alone, thus frequently doubting their approaches (n=12/30, 40%). The most popular communication technique mentioned was adaptation of the quality and quantity of information provided according to each patient’s characteristics (n=29/30, 96.7%); followed by the use of caregivers as mediators for the communication of difficult issues (n=24/30, 80%); balance of realism and hope (n=21/30, 70%); careful choice of wording (e.g. lymphocytosis instead of leukemia) (n=18/30, 60%); gradual disclosure (n=17/30, 56.7%); and, descriptions through pictorial representations or metaphors (n=16/30, 53.3%). Even though physicians did not systematically assess patients’ anxiety and depression levels, they often found themselves dealing with patients’ emotions (n=29/30, 96.7%) through lengthy discussions. With regards to decision making, some mentioned that physicians should make all the decisions (n=9/30, 30%) and that patients are not always willing to take part in the decision-making process (n=8/30, 26.7%), while others were keener on stirring patients towards a decision (n=15/30, 50%), taking into account patients’ preferences (n=10/30, 33.3%). Most physicians felt uncomfortable delivering bad news such as initial diagnosis, relapse and poor prognosis (n=25/30, 83.3%). Self-reported needs included (i) communication skills training (n=20/30, 66.7%); (ii) psychological support (n=7/30, 23.3%); and, (iii) working in a multidisciplinary team (n=8/30, 26.7%).

Conclusion
In the absence of structured communication guidance there is great uncertainty among physicians concerning their skills on communicating CLL nature and handling difficult situations, leading to distress endangering their engagement in a healthy relationship with the patient. Additional studies are warranted at European level for identifying physician needs in different countries aiming at improving their communication skills to support and empower CLL patients for participating in their own care and enhance their QoL.

Session topic: 35. Quality of life, palliative care, ethics and health economics

Keyword(s): Chronic Lymphocytic Leukemia, Quality of Life

Abstract: P378

Type: Poster Presentation

Presentation during EHA22: On Friday, June 23, 2017 from 17:15 - 18:45

Location: Poster area (Hall 7)

Background
Despite recent progress in prognostication and management, chronic lymphocytic leukemia (CLL) remains unpredictable at diagnosis, while virtually incurable, posing challenges to physicians on how to properly communicate the actual nature of the disease. Moreover, the great majority (~85%) of patients do not need treatment at diagnosis, creating a major cognitive dissonance between the perception of leukemia diagnosis and the “wait & watch” strategy usually applied, that may become a major reason of anxiety and quality of life (QoL) impairment for patients and frustration for physicians. Evidently, both patients and physicians need parameters that would allow co-decision making tailored to each particular case.

Aims
To identify physicians’ needs in order to improve their communication skills and thus facilitate CLL patient empowerment through a patient-centeredness model.

Methods
An in-depth qualitative study with semi-structured interviews was conducted within hematologists (n=30) all over Greece. Data collection was considered as completed when saturation was reached i.e. no new themes emerged as assessed by the investigators. Content analysis was performed separately by a hematologist and a health psychologist with 98% inter-rater reliability score.

Results
None of the participants had ever received formal communication training but rather adopted the techniques of senior physicians or developed their own through experience alone, thus frequently doubting their approaches (n=12/30, 40%). The most popular communication technique mentioned was adaptation of the quality and quantity of information provided according to each patient’s characteristics (n=29/30, 96.7%); followed by the use of caregivers as mediators for the communication of difficult issues (n=24/30, 80%); balance of realism and hope (n=21/30, 70%); careful choice of wording (e.g. lymphocytosis instead of leukemia) (n=18/30, 60%); gradual disclosure (n=17/30, 56.7%); and, descriptions through pictorial representations or metaphors (n=16/30, 53.3%). Even though physicians did not systematically assess patients’ anxiety and depression levels, they often found themselves dealing with patients’ emotions (n=29/30, 96.7%) through lengthy discussions. With regards to decision making, some mentioned that physicians should make all the decisions (n=9/30, 30%) and that patients are not always willing to take part in the decision-making process (n=8/30, 26.7%), while others were keener on stirring patients towards a decision (n=15/30, 50%), taking into account patients’ preferences (n=10/30, 33.3%). Most physicians felt uncomfortable delivering bad news such as initial diagnosis, relapse and poor prognosis (n=25/30, 83.3%). Self-reported needs included (i) communication skills training (n=20/30, 66.7%); (ii) psychological support (n=7/30, 23.3%); and, (iii) working in a multidisciplinary team (n=8/30, 26.7%).

Conclusion
In the absence of structured communication guidance there is great uncertainty among physicians concerning their skills on communicating CLL nature and handling difficult situations, leading to distress endangering their engagement in a healthy relationship with the patient. Additional studies are warranted at European level for identifying physician needs in different countries aiming at improving their communication skills to support and empower CLL patients for participating in their own care and enhance their QoL.

Session topic: 35. Quality of life, palliative care, ethics and health economics

Keyword(s): Chronic Lymphocytic Leukemia, Quality of Life

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