How do doctors and patients talk about QoL data in consultations?

AIMS: To explore in detail how oncologists refer to and use QoL
information during consultations and how this does or does not
provide patients with opportunities to become involved in decision
making. Findings will inform the development of a program to train
doctors in the use of QoL data. METHODS: We purposively
selected 22 tape recorded consultations in which doctors explicitly
referred to QoL data from the intervention arm of a previous trial
A-17
(Velikova et al, 2004). In this arm, patients completed the EORTCQLQC-
30 and the Hospital Anxiety and Depression
Scale(HADS)and this was fed back to the doctor prior to the
consultation. Consultations were transcribed and analysed using
conversation analysis to identify patterns in when and how doctors
referred to the QoL data, whether this led to the patient elaborating
on their problems and how treatment decisions were then made.
RESULTS: The QoL data was introduced into the consultation by
doctors either to confirm and validate QoL problems in response to
issues that patients themselves raised or to initiate discussion about a
new topic area. Sometimes reference to the QoL data was integrated
into the doctor_s questions about side effects but other times it was
an _add on_ after these issues had been discussed. Using the data to
focus on a specific QoL issue was more likely to lead to the patient
elaborating on their problems than when doctors made a general
reference to the QoL data. The QoL data was rarely referred to in
making decisions about chemotherapy but was referred to in
decisions to treat side effects such as constipation, pain and nausea.
In these instances, doctors referred to the QoL data as an _external
authority_ to justify advice and treatment decisions, rather than
determine these decisions. CONCLUSIONS: These patterns suggest
that training programs should focus on helping doctors to integrate
the QoL data into their questioning about side effects and to use QoL
data to ask about specific problems, rather than QoL in general.