Advanced cancer patients have a strong cautionary message for physicians who use a computer during clinic visits. A study found that advanced cancer patients see physicians who communicate face to face, without using a computer, as being more compassionate and professional and as having better communication skills.
After watching videotaped clinical vignettes of patient encounters in which some physicians used a computer and some did not, most cancer patients picked the physician using the old-fashioned pencil and paper to be their provider.
The study was discussed on October 23 during a presscast in advance of the Palliative Care in Oncology Symposium 2017 in San Diego, California.
"Our research highlights a very important aspect of doctor-patient communication: how cancer patients perceive doctors when they use the examination room computer during visits," lead study author Ali Haider, MD, of the department of palliative, rehabilitation, and integrative medicine at the University of Texas MD Anderson Cancer Center in Houston, said during the press briefing.
American Society of Clinical Oncology (ASCO) expert and briefing moderator Andrew Epstein, MD, noted in a statement that, on the basis of this study, "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."
The use of EHRs continues to rise in the United States. According to a recent report, as of 2015, nearly 9 in 10 office-based physicians have adopted some form of EHR system, and since 2008, the rate has tripled, Haider said. Yet the full effects of EHR use on physician-patient interactions are not well known, Haider explained.
In a randomized controlled trial, Haider and colleagues compared patient perception of a physician's compassion, communication skills, and professionalism in association with the physician's either using or not using a computer.
A total of 120 advanced cancer patients (65 women; median age, 58 years) watched two short, standardized videos depicting a routine physician-patient office visit. During one visit, the physician was communicating face to face using only a notepad. In the second visit, the physician was using a computer during the encounter. Both videos featured actors who were carefully scripted and who employed the same gestures, expressions, and other nonverbal communication to minimize bias. The patients were unaware of the purpose of the study.
After watching each video, the patients rated their perception of the physician's compassion (using a scale of 0 to 50, with low scores indicating greater compassion), communication skills (a scale of 0 to 70, with high scores indicating better skill), and professionalism (a scale 0 to 20, with high scores indicating a higher degree of professionalism).
The patients rated physicians in the face-to-face video as having more compassion and better communication skills and professionalism than the physicians who used the computer in the exam room.
|After First Video||Face-to-Face Visit||EHR-Use Visit||P Value|
|Compassion (lower scores indicate more compassion)||9||20||0.0003|
The majority of patients (86 of 120, 72%) indicated a preference for physicians who communicated face to face to be their personal health care provider.
"This study gives us the message that patients would prefer that their doctor give them undivided attention. Better communication can enhance patient trust and satisfaction," Haider said.
He noted that the results might have been different had the investigators sampled younger patients who had a higher degree of computer literacy, and he said that such a population might be included in a future study.
Epstein, who acted as briefing moderator, said, "In an age of ubiquitous technology, this study is an important reminder of the need to address the potential for technology to interfere with the patient-clinician interface, which is a critical component of the relationship between these two parties. While I agree that more research is needed, face-to-face communication seems quite possibly the preferred route, despite the pressures all clinicians have to search and document in the medical record."
ASCO 2017 Palliative and Supportive Care in Oncology Symposium. Oral abstract 26, to be presented October 27, 2017.