Consultation Recording Use in Oncology: Why doesn

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Consultation Recording Use in Oncology Why
doesnt evidence alone lead to practice
change?PROFESSOR Tom HackFaculty of Nursing,
University of ManitobaUniversity of Central
Lancashire, England health research with
real impact conference, May 2013
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Clinical Problem

• Information needs are many, varied and persistent
  for newly diagnosed cancer patients
• Patient information needs are highest at the time
  of diagnosis and treatment planning
• The initial consultation is one during which
  fundamental, critical disease, prognosis and
  treatment information is provided to patients

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Clinical Problem

• Patient anxiety is high during the initial
  treatment consultation, making it difficult to
  focus attention on information being communicated
• Patient recall of salient facts from this
  consultation is poor
• Involvement in treatment decision making is
  compromised if recall is poor

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Treatment Consultation

• http//www.youtube.com/watch?featureplayer_detail
  pagevuyyGu5OUD-ot26s

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Solution to Clinical Problem

• Consultation recordings
• reduce anxiety, improve recall of information,
  and enhance patient satisfaction (Cochrane
  Collaboration Systematic Reviews)
• Pitkethly M, MacGillivray S, Ryan R. Recording or
  summaries of consultations for people with cancer
  (Review). The Cochrane Collaboration 2008 Issue
  3.
• Scott JT, Harmsen M, Prictor MJ, Entwistle VA,
  Sowden AJ, Watt I. Recording or summaries of
  consultations for people with cancer (Review).
  The Cochrane Collaboration 2007 Issue 2.

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Challenge with the Solution

• Recordings yield benefits to patients, are rated
  as beneficial by patients, and are supported by
  oncologists, BUT no widespread uptake! Why?
• Can theory help us understand why?
• Can a knowledge management theory help us
  understand why consulting recording uptake into
  clinical practice is weak?

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Theory PARIHS Knowledge Translation Framework
(UK)
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The Evidence

• Consultation recordings
• enhance learning and recall of disease and
  treatment information
• improve communication with family members
• help patients assume an active role in decision
  making
• produce better outcomes than standardized
  recordings
• produce better outcomes than summary letters
• have very high patient satisfaction ratings

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The Evidence

• Hack TF, Ruether JD, Weir LM, Grenier D, Degner,
  LF (2012). Promoting consultation recording
  practice in oncology Identification of critical
  implementation factors and determination of
  patient benefit. Psycho-Oncol. Published online
  July 20, 2012. doi 10.1002/pon.3135.
• Hack TF, Whelan TJ, Olivotto IA, Bultz BD, Weir
  L, Magwood BD, Ashbury F, Brady J. Standardized
  audiotape versus recorded consultation to enhance
  informed consent to a clinical trial in breast
  oncology A feasibility study. Psycho-Oncol
  200616371-6.
• Hack TF, Pickles T, Bultz BD. Ruether JD, Degner
  LF. Impact of providing audiotapes of primary
  treatment consultations to men with prostate
  cancer A multi-site, randomized, controlled
  trial. Psycho-Oncol 200716543-52.
• Hack TF, Pickles T, Bultz BD, Ruether JD, Weir
  LM, Degner LF, et al. Impact of providing
  audiotapes of primary adjuvant treatment
  consultations to women with breast cancer A
  multi-site, randomized, controlled trial. J Clin
  Oncol 2003214138-44.
• McClement SE, Hack TF. Audio-taping the oncology
  treatment consultation a literature review.
  Patient Educ Couns 199936229-38.
• Tattersall MH, Butow PN. Consultation audio
  tapes an underused cancer patient information
  aid and clinical research tool. Lancet Oncol
  20023431-7.
• Tattersall MHN, Butow PN, Griffin AM, Dunn SM.
  The take-home message patients prefer
  consultation audiotapes to summary letters. J
  Clin Oncol 1994121305-11.

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PARIHS Knowledge Translation Framework (UK)
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Context

• Understand and address the contextual factors and
  barriers that influence consultation recording
  use in oncology

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Implementation Study

• Identify the factors and processes associated
  with increased uptake and maintenance of
  consultation recording use

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Method

• Pre-Implementation Contextual Readiness
  Assessment
• Interviews with oncologists
• Interviews with nurses and administrators
• Identify all the barriers to, and facilitators
  of, successful implementation

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Method

• Implementation
• Initial treatment consultations recorded for 228
  cancer patients in 3 Canadian cities
• Patients given recording on USB key
• Patients interviewed on Day 2 post-consultation
  and at Day 7 post-consultation
• Oncologists provided with summary patient
  feedback letter

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Results

• Satisfaction Patients who listened to the
  recording rated the intervention as follows (0
  extreme dislike, 100 extreme like)
• Rating N
• lt 50 1 0.6
• 50-74 9 5.7
• 75-89 20 12.7
• 90-99 57 36.3
• 100 70 44.6

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Results Reduction in anxiety

• I found the recording very helpful. I was told
  originally would not need radiation but when I
  met with Dr. _______ he told me I needed itOnce
  he told me that my mind went blankvery thankful
  I had the recording.
• You listen at the consultation and afterwards I
  had so much running through my head. The first
  night I had trouble going to sleep, so I got up
  and listened to the recording. It really helped
  me settle down.
• A very upsetting experiencefound it very helpful
  to have it the recording. I had to play it back
  so I could remember. There was a lot of
  information that I was not aware of.

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Results Enhanced retention of information

• Hearing it again helps so much. Every time I
  listen to it I get something else out of it. I
  think the recording is a super idea. You take
  everything in but then find you cannot remember
  anything. I will probably listen to it a few
  times in the next few weeks. 
• So happy to have the recording was applying
  information to the wrong thing. Things I forgot,
  my mind is whirling so the recording is very
  beneficial. I missed the measurements in the
  appointment but was able to get it from the
  recording.

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Results Better informed decision making

• Listening to Dr. _____ about the clinical trial
  in the appointment, I wasnt sure what treatment
  I wanted, but once I listened to the recording I
  knew it was not for me. I decided to go the other
  way. The recording has been wonderful and
  excellent.
• Helped with the treatment decision as I thought I
  remembered the doctor saying something but not
  sure, so able to go back and listen again. The
  doctor tells numbers and hard to remember but
  able to hear again. I was unsure whether to have
  oral chemotherapy and this definitely helped with
  that.

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Results - Improved communication with family

• I found it very useful to be able to play for my
  family. My daughters thought it was a wonderful
  idea, seeing as how they do not live here and
  could not attend the consultation.
• My children found the information on the
  recording presented in a very orderly fashion.
  They also stated it was helpful to hear the same
  information their parents had heard.
• My wife was unable to attend the consultation.
  Listening to the recording at home with her
  generated the most open conversation weve had
  about this diagnosis.

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PARIHS Knowledge Translation Framework (UK)
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Consultation Recording Service

• As of May 27, 2013, CancerCare Manitoba will
  offer a Consultation Recording Service to all
  cancer patients attending a pivotal
  appointment.
• Pivotal appointment appointment when a
  significant change in treatment is indicated,
  e.g., initial treatment consultation, recurrence
  consultation, palliative care consultation
• Rolling out this service via disease site
• Starting in Winnipeg and rolling out across
  province of Manitoba

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Critical Factors for Successful Implementation

• Evidence
• Provide oncology staff with evidence fact sheet
• Make key research papers available

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Critical Factors for Successful Implementation

• Context
• Identify implementation champions
• Meet with disease site leaders, chief nursing
  officers, and chief executive officer to secure
  administrative support

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Critical Factors for Successful Implementation

• Context
• Secure commitment of financial and staff
  resources
• to pay for digital recorders and USB keys
• to notify the patient of the option of receiving
  a consultation recording
• to place the digital recorder properly in the
  consultation room
• to transfer the recording to a computer and then
  to a USB key

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Critical Factors for Successful Implementation

• Context
• Technology issues
• USB key storage size (Gb)
• Digital recorders make and model
• USB or website or app
• Medico-legal concerns
• Retain a copy at the cancer centre
• What if the patient loses the USB key?
• What if the patient sues me?

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Critical Factors for Successful Implementation

• Facilitation
• Disease site team meetings
• Launch meetings
• Media campaign
• Monitor and support
• Evaluation audit
• Oncologist feedback summary letter (Research)

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Thank You