Poster Presentation Clinical Oncology Society of Australia 2014 Annual Scientific Meeting

Communication and information processing in patients with primary or metastatic brain malignancy – a survey of practice in two NSW metropolitan radiotherapy centres (#397)

Diana N Naehrig 1 2 , Eng-Siew Koh 3 4 , Monica Vogiatzis 5 , Waka Yanagisawa 3 , Heather L Shepherd 5 6 , Chris G Milross 1 2 , Haryanah M Dhillon 7
  1. Radiation Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
  2. Chris O'Brien Lifehouse, Camperdown, NSW, Australia
  3. University of NSW, Sydney, NSW, Australia
  4. Radiation Oncology, Liverpool Hospital, Liverpool, NSW, Australia
  5. University of Sydney, Camperdown, NSW, Australia
  6. Royal Prince Alfred Hospital, Camperdown, NSW, Australia
  7. CeMPED, Central Clinical School, Sydney Medical School, Camperdown, NSW, Australia

Aims:
Patients with brain malignancy can experience deteriorating cognitive function, with reduced capacity to process and recall complex information. It is unknown if health professionals (HPs) are aware and adapt communication accordingly. We aimed to assess patients’ cognitive function and health literacy, describe current HP practices, and patient perception of communication.

Methods:
At baseline: HPs completed an 11-item questionnaire; patients a 14-item questionnaire and follow-up at 1-2 weeks. Items covered clarity of explanation, information recall, health literacy and surrogate questions for cognitive function using Likert scales. HP use of communication tools was assessed. Patients completed the Montreal cognitive assessment (MoCA) covering 8 cognitive domains; score ≥26/30 implying normal cognition.

Results:
Of the 47 patients recruited, with median age 61 years, 42 (89%) ECOG 0-2, 36 (76%) had secondary brain metastasis. Eighteen patients reported needing help to read medical information and 21 were somewhat, a little bit or not at all confident filling out forms.

On MoCA 13/44 (29%) patients had normal cognition (MoCA score ≥26/30). The average score was 22.

HPs reported using tools during 11 (23%) consultations. They also reported that most patients understood information with verbal explanation alone when speech, jargon, tempo were adapted.

At baseline, patients reported some difficulty with concentration, memory and communication. 35/44 (79%) patients reported the HP explanation was quite or extremely clear. Patients indicated being mostly content with the information received.

At follow-up, 28/39 (71%) patients reported the HP explanation as quite or extremely clear. Although patients recalled illness and treatment details, treatment-related side effects and their management were recalled by 78% and 42% respectively.

Conclusion:
Most of this population had measureable cognitive impairment. Few communication support tools are used by HPs. Despite patients and HP being content with communication, recall of information about treatment toxicity and its management appears impaired. Improved strategies to aid communication and recall are warranted.