1. Fuerst, Mark L.

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SAN DIEGO-Advanced cancer patients prefer their doctors to communicate with them face-to-face with just a notepad in hand rather than repeatedly using a computer, according to a new study.

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"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," noted lead author Ali Haider, MD, Assistant Professor at the University of Texas MD Anderson Cancer Center in the Department of Palliative, Rehabilitation, and Integrative Medicine, Houston.


He presented the findings of the randomized clinical trial at the 2017 Palliative and Supportive Care in Oncology Symposium (Abstract 26).


Video Research

Most doctors have adapted some form of computer software program for managing electronic health records. Yet, the full effect of the use of electronic health records on physician-patient interactions remains unclear. Earlier research shows that people with chronic health concerns, and often accompanying emotional issues, want their doctors to talk to them directly.


Haider and colleagues set out to compare patient perception of physician's compassion, communication skills, and professionalism between a traditional face-to-face clinic visit with a visit where an examination room computer is used by the physician to access and document patient information. The researchers were concerned that the use of the computer might impair communication with patients.


The researchers filmed four approximately 3-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.


In one video, the doctor communicated face-to-face, while in the other video the doctor used the examination room computer during the conversation. Both actors and patients were blinded to the purpose of the study. Investigators were blinded to the sequence of videos watched by the patients.


The patients had localized, recurrent, or metastatic disease; 90 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.


A total of 120 patients were randomly assigned 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.


Communication Results

After watching the first video, the face-to-face clinical encounter resulted in better compassion scores, communication skills, and professionalism. "After crossover analysis, we found a significant effect favoring the second video on compassion scores. After watching the second video, 86 (72%) of the patients preferred face-to-face communication," Haider explained. "Patients perceived physicians who communicated face-to-face without the use of computer as more compassionate, professional, and with better communication skills. Moreover, they preferred the face-to face physician to be their provider.


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


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


"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," stated 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 they would probably find the same results if the study was conducted with people with early-stage cancer. However, they were not so sure about a younger population with higher computer literacy, and they noted that population might be the subject of a future study. New technologies, such as iPads, tablets, and cell phones, would be interesting to look at in future studies, he said.


ASCO Expert Andrew S. Epstein, MD, Medical Oncologist at Memorial Sloan Kettering Cancer Center in New York, commented: "We are in an age of ubiquitous technology. 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."


Mark L. Fuerst is a contributing writer.