Journal Article
. 2020 Sep; 104(2):250-256.
doi: 10.1016/j.pec.2020.08.037.

Characterizing patient-oncologist communication in genomic tumor testing: The 21-gene recurrence score as an exemplar

Suzanne C O'Neill 1 Susan T Vadaparampil 2 Richard L Street 3 Tanina Foster Moore 4 Claudine Isaacs 5 Hyo S Han 2 Bianca Augusto 2 Jennifer Garcia 2 Katherine Lopez 5 Matilda Brilleman 5 Jinani Jayasekera 5 Susan Eggly 4 
  • PMID: 32900604
  •     44 References


Objective: Women with early-stage, ER + breast cancer are recommend to receive genomic profiling tests, such as the 21-gene Recurrence Score (RS) test, to guide treatment decisions. We examined test- and treatment-related information discussed and the associations between RS categories and aspects of communication during patient-oncologist clinical encounters.

Methods: As part of a larger trial, clinical encounters (N = 46) were audiorecorded and coded for 1) RS- and treatment-related information, 2) shared decision making, 3) patient active participation, and 4) oncologist patient-centered communication. We examined differences by RS category using mixed models, adjusting for nesting within oncologist.

Results: Patients with a high RS were more likely to receive a chemotherapy recommendation (p < .01), hear about the risks/side effects of chemotherapy (p < .01), and offer their preferences (p = .02) than those with intermediate or low RS. Elements of shared decision making increased with RS. Oncologist patient-centered communication (M = 4.09/5, SD = .25) and patient active participation (M = 3.5/4, SD = 1.0) were high across RS.

Conclusion: Findings suggest that disease severity, rather than clinical uncertainty, impact treatment recommendations and shared decision making.

Practice Implications: Oncologists adjust test- and treatment-related information and shared decision making by disease severity. This information provides a framework to inform decision making in complex cancer and genomics settings.

Keywords: 21-gene; Breast cancer; Communication; Patient-clinician communication; Shared decision making.

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