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Keywords

physician-patient relationship; pulmonary surgical procedures; integrated delivery of healthcare; decision making; health care disparities; racial disparities; physician opinion; lung cancer; lobectomy.

Abstract

PHYSICIANS’ ATTITUDES ABOUT RECOMMENDING SURGERY FOR EARLY STAGE LUNG CANCER AND POSSIBLE REASONS FOR RACIAL DISPARITIES

ABSTRACT

Purpose: Patient refusal for lung cancer surgery is significant, but other factors, such as negative framing of the treatment discussion, may be involved. Physician attitudes could influence the nuances of and therefore the conclusions of these discussions. We determined physicians’ attitudes and the influence it has on possible decisions against lung cancer surgery, particularly surgical rates for blacks, using a companion survey.

Methods: The study is a prospective, multicenter observational trial conducted at five sites in North and South Carolina from December 2005 to December 2008. Study sites included a mix of academic and community-based health care systems. Enrollment involved generalist, oncology, pulmonary, and thoracic surgery practices. Eighty-four of 100 physicians identified as providing lung cancer advice to 437 patients diagnosed with early stage disease participated. The protocol was approved by each institution’s Institutional Review Board prior to initiating the study. We measured physician demographic information, communication items, physician attitudes, reasons against surgery, and whether these reasons were more true for certain patient populations.

Results: Ninety percent of respondents agreed that medical comorbidities were important factors in recommending against surgery. Only 28% agreed that comorbidities contributed to the racial differences in surgical treatment. Half of respondents felt that non-compliance and difficult communication were at least moderately important in recommending against lung resection surgery and one-fifth regarded these issues to be reasons for black-white surgical disparities. Only 29% and 21% respectively felt that continued smoking or oxygen dependence were reasons to make recommendations against surgery.

Discussion: Physician-patient communication can make a significant impact on decision making regarding lung cancer surgery. Based on the results of this study, half of the physicians felt that “communication with the patient is difficult or inadequate” was a reason to recommend against surgery. A portion of these physicians felt that communication issues was “more true” for black patients. Therefore, methods of improving physician patient communication and systematic serial follow-up should be addressed to potentially reduce racial differences in lung cancer disparities in early stage disease.