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Fewer than 1 in 10 oncology patients demand specific tests or procedures, and their physicians do not often concede when such demands are inappropriate, according to a study published Feb. 12 in JAMA Oncology.
Dr. Keerthi Gogineni and her colleagues at the University of Pennsylvania, Philadelphia, interviewed clinicians working in outpatient oncology clinics at three Philadelphia area hospitals regarding patient encounters between October 2013 and June 2014. A total of 34 oncologists, 11 oncology fellows, and 15 nurse practitioners/physician assistants were interviewed. Among the 5,050 patient encounters, patients demanded or requested treatments in 9% of cases. About 72% were clinically appropriate requests, while 11% were deemed clinically inappropriate by the health providers (JAMA Oncology doi:10.1001/jamaoncol.2014.197).
Of the 440 patient requests, 216 (49%) were for imaging studies; 68 (16%) for palliative treatment of pain, insomnia, or other symptoms; 60 (14%) were for laboratory tests; 23 (5%) were for genetic or chemosensitivity analyses; 30 (7%) were for a clinical trial or experimental treatment; and 16 (3.6%) were for a specific chemotherapy, drug, or biologic agent. (The remaining requests were categorized as “other.”)
Oncology team members agreed to 310 (98%) of the 316 clinically appropriate requests. Of the equivocal ones, they complied with 48 (65%). And among the 50 clinically inappropriate demands or requests, physicians and other providers complied with 7 (14%). Of the total 5,050 patient encounters, clinicians ordered tests or procedures based on improper demands in less than 1% of encounters.
Researchers found no association between patient demands and patient sex, age, race, type of insurance, approximate household income, disease stage, treatment intent, visit type, clinician type, clinician race, or hospital.
Given the rarity of clinically inappropriate demands or requests and that few were complied with, such improper requests are unlikely to add significantly to health care costs, Dr. Gogineni and her colleagues concluded, adding that even requests for clinically appropriate interventions could suggest lack of trust between the doctor and patient and threaten the therapeutic relationship.
Dr. Gogineni and colleagues report that few patient-physician encounters at three cancer centers in Philadelphia involved a patient demand, and the majority of demands made were viewed by the physician as clinically appropriate.
Suddenly, the demanding cancer patient looks less like a budget buster and more like an urban myth. In the wake of these findings, the question now deserving of our attention is: Why does the myth of the demanding patient have so much traction?
My new hypothesis is that these findings say more about our own clinical sensibilities than about our patients. The real point of the study by Dr. Gogineni is this: We have to stop blaming patients for being demanding. The myth of the demanding patient is more about our own responses and how lackluster communication skills can contribute to difficult situations that stick in our throats and our memories.
Dr. Anthony L. Back of the Seattle Cancer Care Alliance and the University of Washington in Seattle made these comments in an accompanying editorial (doi:10.1001/jamaoncol.2014.185). He reported no relevant conflicts of interest.
Dr. Gogineni and colleagues report that few patient-physician encounters at three cancer centers in Philadelphia involved a patient demand, and the majority of demands made were viewed by the physician as clinically appropriate.
Suddenly, the demanding cancer patient looks less like a budget buster and more like an urban myth. In the wake of these findings, the question now deserving of our attention is: Why does the myth of the demanding patient have so much traction?
My new hypothesis is that these findings say more about our own clinical sensibilities than about our patients. The real point of the study by Dr. Gogineni is this: We have to stop blaming patients for being demanding. The myth of the demanding patient is more about our own responses and how lackluster communication skills can contribute to difficult situations that stick in our throats and our memories.
Dr. Anthony L. Back of the Seattle Cancer Care Alliance and the University of Washington in Seattle made these comments in an accompanying editorial (doi:10.1001/jamaoncol.2014.185). He reported no relevant conflicts of interest.
Dr. Gogineni and colleagues report that few patient-physician encounters at three cancer centers in Philadelphia involved a patient demand, and the majority of demands made were viewed by the physician as clinically appropriate.
Suddenly, the demanding cancer patient looks less like a budget buster and more like an urban myth. In the wake of these findings, the question now deserving of our attention is: Why does the myth of the demanding patient have so much traction?
My new hypothesis is that these findings say more about our own clinical sensibilities than about our patients. The real point of the study by Dr. Gogineni is this: We have to stop blaming patients for being demanding. The myth of the demanding patient is more about our own responses and how lackluster communication skills can contribute to difficult situations that stick in our throats and our memories.
Dr. Anthony L. Back of the Seattle Cancer Care Alliance and the University of Washington in Seattle made these comments in an accompanying editorial (doi:10.1001/jamaoncol.2014.185). He reported no relevant conflicts of interest.
Fewer than 1 in 10 oncology patients demand specific tests or procedures, and their physicians do not often concede when such demands are inappropriate, according to a study published Feb. 12 in JAMA Oncology.
Dr. Keerthi Gogineni and her colleagues at the University of Pennsylvania, Philadelphia, interviewed clinicians working in outpatient oncology clinics at three Philadelphia area hospitals regarding patient encounters between October 2013 and June 2014. A total of 34 oncologists, 11 oncology fellows, and 15 nurse practitioners/physician assistants were interviewed. Among the 5,050 patient encounters, patients demanded or requested treatments in 9% of cases. About 72% were clinically appropriate requests, while 11% were deemed clinically inappropriate by the health providers (JAMA Oncology doi:10.1001/jamaoncol.2014.197).
Of the 440 patient requests, 216 (49%) were for imaging studies; 68 (16%) for palliative treatment of pain, insomnia, or other symptoms; 60 (14%) were for laboratory tests; 23 (5%) were for genetic or chemosensitivity analyses; 30 (7%) were for a clinical trial or experimental treatment; and 16 (3.6%) were for a specific chemotherapy, drug, or biologic agent. (The remaining requests were categorized as “other.”)
Oncology team members agreed to 310 (98%) of the 316 clinically appropriate requests. Of the equivocal ones, they complied with 48 (65%). And among the 50 clinically inappropriate demands or requests, physicians and other providers complied with 7 (14%). Of the total 5,050 patient encounters, clinicians ordered tests or procedures based on improper demands in less than 1% of encounters.
Researchers found no association between patient demands and patient sex, age, race, type of insurance, approximate household income, disease stage, treatment intent, visit type, clinician type, clinician race, or hospital.
Given the rarity of clinically inappropriate demands or requests and that few were complied with, such improper requests are unlikely to add significantly to health care costs, Dr. Gogineni and her colleagues concluded, adding that even requests for clinically appropriate interventions could suggest lack of trust between the doctor and patient and threaten the therapeutic relationship.
Fewer than 1 in 10 oncology patients demand specific tests or procedures, and their physicians do not often concede when such demands are inappropriate, according to a study published Feb. 12 in JAMA Oncology.
Dr. Keerthi Gogineni and her colleagues at the University of Pennsylvania, Philadelphia, interviewed clinicians working in outpatient oncology clinics at three Philadelphia area hospitals regarding patient encounters between October 2013 and June 2014. A total of 34 oncologists, 11 oncology fellows, and 15 nurse practitioners/physician assistants were interviewed. Among the 5,050 patient encounters, patients demanded or requested treatments in 9% of cases. About 72% were clinically appropriate requests, while 11% were deemed clinically inappropriate by the health providers (JAMA Oncology doi:10.1001/jamaoncol.2014.197).
Of the 440 patient requests, 216 (49%) were for imaging studies; 68 (16%) for palliative treatment of pain, insomnia, or other symptoms; 60 (14%) were for laboratory tests; 23 (5%) were for genetic or chemosensitivity analyses; 30 (7%) were for a clinical trial or experimental treatment; and 16 (3.6%) were for a specific chemotherapy, drug, or biologic agent. (The remaining requests were categorized as “other.”)
Oncology team members agreed to 310 (98%) of the 316 clinically appropriate requests. Of the equivocal ones, they complied with 48 (65%). And among the 50 clinically inappropriate demands or requests, physicians and other providers complied with 7 (14%). Of the total 5,050 patient encounters, clinicians ordered tests or procedures based on improper demands in less than 1% of encounters.
Researchers found no association between patient demands and patient sex, age, race, type of insurance, approximate household income, disease stage, treatment intent, visit type, clinician type, clinician race, or hospital.
Given the rarity of clinically inappropriate demands or requests and that few were complied with, such improper requests are unlikely to add significantly to health care costs, Dr. Gogineni and her colleagues concluded, adding that even requests for clinically appropriate interventions could suggest lack of trust between the doctor and patient and threaten the therapeutic relationship.
Key clinical point: The majority of oncology patients do not demand appropriate care.
Major finding: Among 5,050 patient encounters, patients demanded or requested treatments in 9% of cases. About 72% were clinically appropriate requests, while 11% were rated clinically inappropriate.
Data source: Interviews of 60 oncologists and team member from three Philadelphia area hospitals.
Disclosures: No conflicts of interest were reported.
