“The rapid uptake of electronic health records in oncology has given us a large set of data we can use to improve care.

Based on this study, however, we clearly need to be mindful about using computers during exam time, especially for patients with advanced cancer, and consider what they value in their interactions with doctors,” said ASCO Expert Andrew S. Epstein, MD, moderator of today’s presscast.

A new study suggests that people with advanced cancer prefer doctors communicate with them face-to-face with just a notepad in hand rather than repeatedly using a computer. These findings will be presented at the upcoming 2017 Palliative and Supportive Care in Oncology Symposium in San Diego, California.

“To our knowledge, this is the only study that compares exam room interactions between people with advanced cancer and their physicians, with or without a computer present,” said lead study author Ali Haider, MD, an Assistant Professor at the University of Texas MD Anderson Cancer Center in the Department of Palliative, Rehabilitation, and Integrative Medicine, which also funded the study.

Many doctors now use a computer software program for managing electronic health records. The researchers were concerned that it might impair communication with patients and also knew from earlier research that people with chronic health concerns, and often accompanying emotional issues, want their doctors to talk to them directly.

About the Study
The researchers filmed four approximately 2-minute videos that featured actors who were carefully scripted and used the same gestures, expressions, and other nonverbal communication in each video to minimize bias:

Video 1: Doctor A in a face-to-face consultation with just a notepad in hand
Video 2: Doctor A in a consultation using a computer
Video 3: Doctor B in a face-to-face consultation with just a notepad in hand
Video 4: Doctor B in a consultation using a computer
The patients in the study had either localized, recurrent, or metastatic disease. Ninety percent were fully physically functional, and all were English speakers. To further standardize and control their assessment, the researchers captured patient information on psychosocial factors, age, and level of education upon enrollment.

The researchers randomly assigned 120 patients to four equal-sized groups. After viewing their first video, the patients completed a validated questionnaire rating the doctor’s communication skills, professionalism, and compassion. Subsequently, each group was assigned to a video topic (face-to-face or computer) they had not viewed previously featuring an actor-doctor they had not viewed in the first video. A follow-up questionnaire was given after this round of viewing, and the patients were also asked to rate their overall physician preference.

Key Findings
After the first round of viewing, the patients rated doctors in the face-to-face video as having more compassion and better communication skills and professionalism than the doctors who used the computer in the exam room. After having watched both videos, 72% of participants favored the face-to-face interaction.

“We know that having a good rapport with patients can be extremely beneficial for their health,” said Dr. Haider. “Patients with advanced disease need the cues that come with direct interaction to help them along with their care.”

The researchers note that their study answers questions about patients’ perceptions, but not how to address the issue of computer use in an exam room.

Next Steps
“Our study was done at an outpatient clinic, so it is probably more pertinent in that setting compared to a hospital where patient-doctor interactions are more frequent and rigorous,” said Dr. Haider. “We are pretty certain that people will permit another entity in the exam room, but our study shows that if the third entity is a computer, the computer is not preferred.”

The researchers believe that they would probably find the same results if the study was conducted with people with early-stage cancer. However, they weren’t so sure about a younger population with higher computer literacy and said that population might be the subject of a future study.

Source: American Society of Clinical Oncology (ASCO)

Full bibliographic information
2017 Palliative and Supportive Care in Oncology Symposium