How do doctors integrate HRQoL data into oncology consultations?

Aims
To explore how oncologists integrate HRQoL data into consultations with patients and identify good practice in discussing HRQoL data in consultations.
Methods
We purposively selected 18 tape recorded consultations in which doctors explicitly referred to QoL data from the intervention arm of a previous trial (Velikova et al, 2004). Patients completed the EORTC-QLQC-30 and the Hospital Anxiety and Depression Scale (HADS) which was fed back to the doctor prior to the consultation. Consultations were transcribed and analysed using conversation analysis and divided into three categories: (1) HRQoL data integrated into the consultation; (2) HRQoL data semi integrated and (3) HRQoL data not integrated
Results
In the integrated category (n=8), the HRQoL data was referred to during the initial discussion of symptoms and chemotherapy side effects and before the decisions about chemotherapy or supportive treatments had been made. Issues raised by the HRQoL data influenced decisions about supportive treatments to control the side effects of the chemotherapy and in two cases the dose of chemotherapy was changed. In the semi-integrated category (n=6), the HRQoL data was referred to during the discussion of the side effects of chemotherapy but after decisions about chemotherapy were made. It was made relevant to decisions about supportive treatments to control the side effects of the chemotherapy or to strengthen and reinforce previous decisions to change or maintain the current dose of chemotherapy. In the not integrated category (n=4), the HRQoL data was only raised towards the very end of the consultation, when the patients’ main problems had been identified and discussed and the decision about chemotherapy had been made. It did not influence decisions about supportive treatments or chemotherapy.
Conclusions
In order to have the maximum impact on decisions about supportive treatments or chemotherapy, oncologists need to refer to HRQoL data at the start of the consultation during their routine evaluation of chemotherapy side effects and before decisions about continuing chemotherapy or controlling side effects have been made.