Systematic communication model to facilitate conversations about metastatic breast cancer.

Abstract

11141 Background: For patients with metastatic breast cancer (mBC) understanding their stage and treatment goals is essential to engage in shared decision-making. However, patient-physician communication challenges often hinder discussions about this information. This study evaluated a systematic communication model designed to guide conversations on mBC and to ease oncologists’ experience when conveying this delicate information. Methods: Patents starting 1st-line mBC treatment were included at 7 referral centers in Mexico. During the consultation in which mBC was disclosed, their oncologists followed a 9-step communication model that facilitated and promoted conversations about mBC stage, treatment, and prognosis, considering each patient's information preferences. After 3-10 days, patients completed a survey assessing understanding of their mBC stage and treatment, and satisfaction. Oncologists also completed a survey exploring their experience providing the information. This study was funded by Pfizer. Results: 50 patients were included by 10 oncologists. Patients’ median age was 55 yrs (IQR 15); most had ≤high school education (55%) and had recurrent mBC (63%). After receiving information through the communication model, 78% of patients were aware that their BC was metastatic, 56% that mBC is not curable, 76% that their treatment’s main objective was to improve their lifespan and quality of life, and 70% that their treatment had no established end date. Patients reported having discussed their prognosis with their oncologist in 54% of cases, most of which considered this information was very useful for: making treatment decisions (94%), preparing for the future (92%), and keeping hope (92%). Overall, most (78%) were satisfied with the way in which they received information about their mBC. As for oncologists’ experience, they considered the communication model was very helpful to better convey the incurability of mBC (76%), treatment objectives (82%), and prognosis (42%). With all patients, oncologists were very satisfied (46%) or satisfied (54%) after implementing the model. They felt anxious in 2% of cases, stressed in 2%, confident in 90%, and calm in 90%; their distress thermometer score was ≥4/10 in 26% of consultations. Of note, oncologists reported not completing ≥1 step of the model in 44% of consultations, mostly due to limited time (46%) and forgetfulness (29%). Compared to their usual practice, they considered that the model did not affect (42%) or moderately increased (50%) the duration of the consultation. Conclusions: Both patients and oncologists were highly satisfied with the way in which mBC information was disclosed through the communication model. Oncologists particularly recognized the model as a valuable aid for these conversations. Yet, prognosis was discussed with a limited proportion of patients, underscoring the need for further efforts to ease approaching this topic.