Illustration of a patient and a health care provider with a tablet

Choice 2.0

Improving Patient-Provider Communication in Cancer Care

The Research Council of Norway # 177500

Patient-centred communication and incorporating patients’ illness experiences into patient care are high priority health policy goals. However, this is difficult to accomplish without methods and systems that assist patients in sharing their illness experiences and clinicians in integrating this information into patient care. Choice is a computer-based interactive patient assessment and communication system designed for this purpose.

This interdisciplinary research study tested the effects of  the Choice application in a clinical trial with 193 in- and outpatient cancer patients. In the intervention group patients completed the Choice assessment in preparation to their consultation on a tablet computer, where they denoted their symptoms, problems and concerns, including the degree of bother and priority for care. The resulting assessment summary was available to both patients and their nurses or physicians during the consultation. The control group received usual care. All consultations were audio-taped and analyzed for their content.

The study found that when the Choice application was used to support patient-provider communication, significantly more symptoms were addressed during the consultations. Patients participated more actively in the consultations in two ways:  by asking more questions and by expressing more emotional concerns, or cues to emotional concerns, that were also expressed more explicitly than in the control group. Physicians and nurses did not change their response style, but provided more information to patients in the intervention group. More cues and concerns were addressed in consultations with nurses compared to physicians, and significant differences in response styles between nurses and physicians were found.  Physicians were more information giving while nurses were more emotionally responsive. Finally, more cues and concerns were expressed early in the consultation.

In summary, this is the first known study to test the effects of an interactive patient assessment and communication system  on patient-centered care communication between cancer patients and clinicians. Our findings support that the Choice application can successfully support patient-centered communication and care in regular clinical practice. Choice may become even more successful if  accompanied with communication skills training to potentially produce more patient-centered responses on the part of clinicians.