Chapter 9
they do not explicitly communicate this to patients, the choices oncologists make in terms of what they disclose to patients and how they formulate this information, could imply their personal preference. The findings of the study we report in Chapter 8 support this hypothesis (this study is discussed under key finding VII). III. Adjuvant! is regularly used by medical oncologists to inform patients about their prognosis and the potential treatment benefit (Chapter 5 and 6) Summary In Chapter 5 we assessed surgical and medical oncologists’ frequency of use and motivation for employing prediction tools using an online survey (N= 51). The best known (95%) and most frequently used (96%) prediction tool was Adjuvant!. Our respondents indicated they regularly used it to inform their own treatment advice (86%), to inform patients about their prognosis (>80%), and to convince patients either to forego or undergo treatment, particularly chemotherapy (74%). Three quarters of respondents felt that using Adjuvant! during the consultation helped patients to better understand their prognosis. As Adjuvant! was the most frequently used prediction tool, in Chapter 6 we focused on how often Adjuvant! was actually used prior to and during consultations with patients, and which factors were associated with its use. To this end, we used 287 audiotaped consultations. We found that medical oncologists consulted Adjuvant! prior to 70% of consultations to inform themselves, and it was used during two thirds of consultations. Adjuvant! was used less frequently during consultations with patients with TNM stage II/III than with stage I. Adjuvant! use was also associated with medical oncologists’ age, with the older medical oncologists using Adjuvant! less often, both prior to and during consultations, than their younger counterparts. In sum, medical oncologists frequently use Adjuvant! both prior to and during patient consultations to inform patients about their prognosis, convince them about their proposed treatment plan. A majority of surgical and medical oncologists believe that using Adjuvant! helps their patients to better understand their prognosis. Use of Adjuvant! was less frequent in older oncologists and during consultations with patients with stage II/III disease. Reflections and Future Directions The higher the disease stage, the poorer the prognosis, and medical oncologists might be hesitant to communicate such probabilities. Receiving explicit information about poor prognosis might prove difficult for patients to come to terms with, cause them anxiety, and/or demotivate them. Also, medical oncologists might be more inclined to discuss the prognostic probabilities when treatment benefit is limited, in order to convince patients that undergoing treatment is not worthwhile. Indeed in our survey
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