The Take-Home Message: Patients Prefer Consultation Audiotapes to Summary Letters By Martin H.N. Tattersall, Phyllis N. Butow, Anne-Marie Griffin, and Stewart M. Dunn Purpose: Despite reports of poor patient understand- ing and recall after cancer consultations, few doctors provide communication aids. We conducted a random- ized trial comparing an audiotape of the consultation versus individualized summary letters to patients after their first consultation with a medical oncologist. Methods: One hundred eighty-two cancer patients were randomized to receive either (1) the audiotape fol- lowed 7 to 10 days later by the letter or (2) the letter followed by the audiotape. Outcome measures included patient recall, anxiety and depression, satisfaction with and use of the communication aids, and patient prefer- ences for six communication options. Demographic and disease variables and information and involvement pref- erences were documented. Results: Eighty percent of patients wanted all infor- mation and 72% wanted to participate in treatment deci- THE NOTION of the patient as a passive recipient of health care has changed in most Western countries during the past 30 years,' and the patient is increasingly expected to be an informed participant in management decisions. 24 To make informed decisions, patients must understand, evaluate, and retain complex information. However, patients are commonly less than satisfied with the information they receive. 5 The possible costs of poor understanding include loss of confidence in staff and dissatisfaction with medical care 6 ; increased anxiety, distress, and coping difficulties 7 ; and noncompliance with treatment. 3 " Several sources of poor patient understanding have been recognized, includ- ing poor communication techniques and lack of time in the consultation, 5 patient shock and anxiety,' and patient denial, 3 ' 0 sometimes accompanied by doctors deliberately witholding information considered detrimental to patient welfare."" Thus, interventions aimed to improve patient understanding need to neutralize anxiety and provide an opportunity for information review, be sensitive to pa- tients' varying information needs, and be economical in terms of time and cost. Personalized letters to patients after a consultation ap- pear to satisfy these criteria, and have been reported to improve patient understanding.' 2 " 6 The provision of au- diotapes of the cancer patient's consultation with a sur- geon and medical oncologist has also been studied, and these approaches have been widely supported by special- ists and general practitioners. 720 We now report the re- sults of a randomized trial comparing an audiotape of the consultation with individualized letters to cancer patients, after their first consultation with a medical oncologist. sions. Patients listened to the tape on average 2.3 times and read the letter 2.8 times over 4 weeks, and 90% showed the tape or letter to a friend, relative, or doctor. Satisfaction with the tape and letter were uniformly high and they did not differentially affect recall, anxiety, or depression. When asked to rank six communication op- tions, 46% of patients gave the highest rank to the tape and 21% to the letter. Conclusion: Patients use audiotapes of their cancer consultation and individualized letters to review the in- formation given and communicate information to rela- tives and friends. They prefer audiotapes to letters. Clini- cians should consider installing audiotape-recording facilities that could be used to tape new-patient consulta- tions. J Clin Oncol 12:1305-1311. o 1994 by American So- ciety of Clinical Oncology. METHODS Study Design The study was a randomized, single-blind, cross-over trial of the efficacy of communication aids, involving cancer patients attending their first consultation with a medical oncologist at a University teaching hospital (Fig 1). The study was restricted to patients of a single oncologist to control for the impact of varying consultation and letter-writing styles and to maximize patient and physician com- pliance. Applying the staged approach to cancer research' we wished to trial the interventions under optimal conditions to deter- mine their effects on the outcome measures. If effective, they could be investigated more widely within oncology practice. All patients were seen before the consultation by an oncology nurse specialist to assess eligibility for the study. Eligible patients were asked to fill out the Hospital Anxiety and Depression scale (HAD) 2 and two items on involvement and information preferences derived from the Information Styles Questionnaire developed by Cassileth et al.' Subject to patient agreement (100%), the consulta- tion was then audiotaped. Immediately after the consultation, the medical oncologist documented what he thought were the most im- portant or salient points covered and prepared a letter summarizing the consultation, consisting essentially of his salient points. Patients were randomized to receive the communication aids in the order of From the Department of Cancer Medicine, University of Sydney, Sydney; and Medical Psychology Unit, Departments of Psychiatry, Endocrinology, and Cancer Medicine, Royal Prince Alfred Hospital, Sydney, Australia. Submitted November 1, 1993; accepted February 1, 1994. Supported by the Leo and Jenny Leukemia and Cancer Founda- tion. Address reprint requests to Martin H.N. Tattersall, MD, Depart- ment of Cancer Medicine, University of Sydney, NSW Australia. © 1994 by American Society of Clinical Oncology. 0732-183XA94/1206-0030$3.00/0 Journal of Clinical Oncology, Vol 12, No 6 (June), 1994: pp 1305-1311 1305 Information downloaded from jco.ascopubs.org and provided by at UCLA on July 30, 2011 from 164.67.83.5 Copyright © 1994 American Society of Clinical Oncology. All rights reserved.