"Even if I Don't Remember, I Feel Better". A Qualitative Study of Patients with Early-Stage Non-Small Cell Lung Cancer Undergoing Stereotactic Body Radiotherapy or Surgery

• Published in: Annals of the American Thoracic Society Vol. 13; no. 8; pp. 1361 - 1369
• Main Authors: Golden, Sara E, Thomas, Jr, Charles R, Deffebach, Mark E, Sukumar, Mithran S, Schipper, Paul H, Tieu, Brandon H, Kee, Andrew Y, Tsen, Andrew C, Slatore, Christopher G
• Format: Journal Article
• Language: English
• Published: United States American Thoracic Society 01-08-2016
• Subjects: Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung - psychology; Carcinoma, Non-Small-Cell Lung - therapy; Communication; Conflict (Psychology); Decision Making; Female; Humans; Interviews as Topic; Lung Neoplasms - psychology; Lung Neoplasms - therapy; Male; Middle Aged; Patient Outcome Assessment; Patient Participation; Patient Satisfaction; Prospective Studies; Qualitative Research; Radiosurgery; Stress, Psychological; United States; communication; thoracic diseases; patient-centered outcomes
• DOI: 10.1513/AnnalsATS.201602-130OC
• EISSN: 2325-6621
• ISSN: 2329-6933

While surgical resection is recommended for most patients with early stage lung cancer according to the National Comprehensive Cancer Network guidelines, stereotactic body radiotherapy is increasingly being used. Provider-patient communication regarding the risks and benefits of each approach may be a modifiable factor leading to improved patient-centered outcomes.
To qualitatively describe the experiences of patients undergoing either surgery or stereotactic body radiotherapy for early stage non-small cell lung cancer.
We qualitatively evaluated and used content analysis to describe the experiences of 13 patients with early clinical stage non-small cell lung cancer before undergoing treatment in three health care systems in the Pacific Northwest, with a focus on knowledge obtained, communication, and feelings of distress.
Although most participants reported rarely having been told about other options for treatment and could not readily recall many details about specific risks of recommended treatment, they were satisfied with their care. The patients paradoxically described clinicians as displaying caring and empathy despite not explicitly addressing their concerns and worries. We found that the communication domains that underlie shared decision making occurred infrequently, but that participants were still pleased with their role in the decision-making process. We did not find substantially different themes based on where the participant received care or the treatment selected.
Patients were satisfied with all aspects of their care, despite reporting little knowledge about risks or other treatment options, no direct elicitation of worries from providers, and a lack of shared decision making. While the development of effective communication strategies to address these gaps is warranted, their effect on patient-centered outcomes, such as distress and decisional conflict, is unclear.