Retrospective analysis of communication with patients undergoing radiological breast biopsy
This study explored the perceptions of women after receiving breast biopsy results over the phone in order to determine patient preferences about the timing, setting, and provider they preferred when receiving biopsy results. Participants were recruited at a large university cancer center and surveyed by phone approximately 2 weeks after they received biopsy results. A 24-item survey was developed concerning how the biopsy results were communicated, the communication skills of the person reporting the diagnosis, and ways to improve the communication of results. The survey also asked about the relative importance of hearing the results quickly, from the most knowledgeable provider, from a primary care physician, or in person. We surveyed 59 patients (25 cancer, 34 benign). Patients from both groups were satisfied with the communication skills of the person who gave the results. However, patients with cancer and patients undergoing their first breast biopsy were more likely to need additional materials to understand their results (P = 0.018, P = 0.036, respectively). Both cancer and benign groups ranked hearing the results quickly as the most important aspect of communication and hearing the results in person as least important. This study suggests that patients value hearing cancer diagnoses quickly more than in person. Patients having their first biopsy or with a diagnosis of cancer would prefer to have additional materials to help them understand their diagnosis.
Correspondence to: Robert M. Arnold, MD, Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, Montefiore University Hospital, 3459 Fifth Avenue Suite 932 West, Pittsburgh, PA 15213; telephone: (412) 692-4810; Fax: (412) 692-4892
Patient Priorities for Receiving Biopsy Results
For patients with benign and those with malignant disease, receiving results quickly was the most important factor, followed by being told by a person who knows the most about what the results mean (Figure 2). Hearing from a primary care provider and hearing in person were of much lower priority. Cancer patients ranked “Being told by a person who knows the most about what the results mean” significantly higher in priority than benign patients (P < 0.05).
Discussion
,In our study population of women who had a breast biopsy, the number one priority was receiving the results as soon as possible. We found that women were generally satisfied with learning about their results from a nurse over the phone. However, a majority of patients said they would prefer additional materials to help them understand their diagnosis. This trend was more pronounced in women with cancer or those for whom this was the first biopsy. Previous literature has shown that both doctors and patients agree that potentially bad news should be given in a quiet, uninterrupted, face-to-face conversation3 and that it should be given by a provider they know well.8 However, it has also been suggested that many women want to hear test results as quickly as possible, even if that means they will receive them from a provider they do not know well.[3], [4] and [5] This study is unique in that it forced women to choose which of these aspects of communication were most important as we believe that rapid results and hearing in person are often mutually exclusive. Women in this study clearly preferred to hear quickly more than in person, whether they were given a diagnosis of cancer or not.
Some studies suggest that providing written information along with verbal communication would be beneficial. For example, in a 2004 study by Lobb et al,9 genetic counselors who added a summary letter after communicating breast cancer risks to a patient significantly increased realistic risk assessments in patients, as well as lowering anxiety. Our study found that women would prefer additional materials. Since most communication in this study was over the phone, women may not have had time to fully process all the information given and therefore wanted information supplements as well. In women with cancer or those receiving a first biopsy, information and follow-up instructions are even more complex or overwhelming; and it follows that they are more likely to want informational materials than other patients.
As expected, patients who are diagnosed with cancer want to talk to someone with more knowledge of their specific condition. While patients in this study were not asked specifically about the apparent knowledge base of the nurse who gave results, their overall satisfaction (86.4%) seems to suggest that our system with specific scripts for each diagnosis was adequate.
This study is limited in several ways. First, as a single-center satisfaction study, we are only measuring the experience of patients with a particular system of communication. While these data reflect the general system in place at the breast center, they are also contingent on the specific providers communicating with patients. However, we do believe our results are reproducible at other centers as scripts are often used for sharing patient results. This also means that these data are a reflection of a population that was contacted by telephone. We cannot make any assumptions about how these preferences may differ from those of patients contacted in person. Second, only general data were gathered about the interaction of the nurse with each woman. It is not known what was specifically said to each patient, so we can only report the patient's view of the discussion. However, since responses are scripted at the breast center, we assume that the communication was relatively standardized for all conversations. Third, patients in the study were more likely to have a cancer diagnosis than the total population of biopsy patients. This may represent a greater commitment by cancer patients to aid in the improvement of communication. It also may indicate that women with a benign biopsy were less opinionated about their communication in general and less likely to want to express their opinions in the study.
In conclusion, patients generally prefer to hear breast biopsy results quickly over other factors, including hearing in person or from a more experienced practitioner. Therefore, a program similar to the one at our center meets most patient needs; it minimizes wait time by calling patients as soon as biopsy results are in, utilizes nurses to facilitate the large amount of calls that must be made every day, and ensures patients are contacted by a provider they personally met during their biopsy. A majority of patients desired additional materials to supplement phone communication. We highly recommend providing a variety of materials, including both written and Web-based, to address this need. Further research is necessary to determine the effects of these interventions on patient understanding and long-term emotional outcomes.
