Becker's Clinical Quality & Infection Control

21 PATIENT EXPERIENCE Physicians shortchanging patients in cancer-screening discussions, study finds By Megan Knowles D espite national guidelines advising physicians to talk to high-risk patients about the benefits and harms of lung cancer screening, those discus- sions may not be occurring properly, a study published in JAMA Internal Medicine found. The study, led by Chapel Hill-based University of North Carolina Lineberger Comprehensive Cancer Center re- searchers, looked at audio from14 office visit discussions between physicians and patients. The quality of the conversation about lung cancer screen- ing was "poor," and discussion of a screening's potential harm was "virtually nonexistent," the researchers found. On average, the physicians spent less than a minute talking about the issue, the study found. "We're not taking a side as to whether lung cancer screening is good or bad, but there seems to be a consensus that we should be sharing these complex decisions with patients," said senior study author Daniel Reuland, MD. "Our fly-on-the-wall sample from real-world practice shows us that's not happening." The research team analyzed 14 screening discussions from a large database of conversations between physi- cians and patients. They found the conversations by elec- tronically searching 5,300 recorded interactions between physicians and age-eligible patients. Only 14 conversations out of 137 that met keyword criteria addressed lung cancer screening specifically. The conversations were brief and one-sided, and none of the physicians discussed the potential harms of screen- ing, the researchers found. No physician explained false positive test results or the potential need for additional imaging or invasive diagnostic procedures. "We need to design systems that make patient care and medical decisions more informed and shared, and we need to take that responsibility seriously," Dr. Reuland said. "Issuing guidelines and payer-based regulations say- ing we should be doing shared decision-making is fine, but it isn't enough. Among other things, we need more efficient and reliable ways of getting patients involved in these decisions." n New Jersey physician advocates for providers to give patients 40 seconds of undivided attention By Harrison Cook S tephen Trzeciak, MD, a critical care physician at Cam- den, N.J.-based Cooper University Health Care, gave a TedxPenn talk about what he believes is the most pressing problem we face today as a society: a compas- sion crisis in healthcare. Dr. Trzeciak further discussed this concept during an August 6 podcast from Knowledge@Wharton, an online business journal of the Wharton School of the University of Pennsylvania in Philadelphia. Here are five things to know: 1. After his 12-year-old son asked for help preparing a speech on the most pressing problem of our time, Dr. Trzeciak realized he was not following the same advice he was about to give. This led to the question: Does com- passion really matter? 2. Dr. Trzeciak conducted a systematic review of bio- medical literature and determined compassion is important to patients and patient care. 3. However, he identified physicians' increased time looking at computer screens or EHRs, and less time spent with patients, as a contributing factor to this compassion crisis. Fifty-six percent of physicians feel they don't have time to be compassionate in their daily routine, accord- ing to a study published in the Journal of General Internal Medicine and cited by Dr. Trzeciak. 4. Dr. Trzeciak coined the term "compassionomics" to highlight the connection between more compassionate, patient-centered care and lower healthcare costs. "The bottom line is that if healthcare providers actually spend more time connecting with patients and talking with them, maybe we don't need all these tests and referrals," he said on the podcast. 5. Dr. Trzeciak cited a second study from Balti- more-based Johns Hopkins University School of Medicine measuring compassion intervention among cancer patients. When oncologists met with patients and shared messages of compassion, it only took 40 seconds to lower patients' anxiety."When you're a healthcare provider and you tell me you don't have enough time to be compassionate, you probably have 40 seconds," Dr. Trzeciak said on the podcast. n

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