WHO INITIATES CANCER SYMPTOM MANAGEMENT DISCUSSIONS? FACTORS ASSOCIATED WITH PATIENT VS. CLINICIAN INITIATION IN WOMEN WITH OVARIAN CANCER

Purpose: Women with ovarian cancer experience multiple, co-occurring symptoms that impact functioning and quality of life. Research suggests that patient-clinician communication about symptoms is suboptimal, yet there is little research exploring factors that influence symptom communication. The purpose of this study is to describe symptom communication and to explore factors associated with patient vs. clinician initiation of symptom discussions.

Method: Forty-six women receiving chemotherapy for ovarian cancer and experiencing ≥ 2 symptoms completed a Sociodemographic Questionnaire, the MD Anderson Symptom Inventory, the Symptom Communication Questionnaire, and the Symptom Management Barriers Questionnaire immediately following a clinic appointment. Variables were created to capture the percentage of symptoms experienced that were discussed by the patient-clinician dyad and the percentage of discussions that were initiated by the patient. Nonparametric statistical tests were applied to assess the relationship between sociodemographic factors, attitudinal barriers, symptom discussions, and initiation of discussions by patient.   

Result: Women had a mean age of 57.73 years (SD = 10.01), all were white, 65.9% were married, 36.4% had finished college, 50% worked full/part-time, and the median household income was > $ 50,000. Women experienced 9 ± 4 concurrent symptoms (range 2-18), with a mean severity of 4.07 on a 0-10 scale (SD = 1.26). On average, women discussed 4 symptoms (SD = 3) (range 0-10) during their appointment, and 58.1% of the discussion were initiated by the patients. In general a higher overall barrier score was associated with fewer symptom discussions. However, the higher the barriers score, the higher the percentage of discussions that were initiated by patients (ρ =.333, p = .031).  Specific factors associated with patients initiating the discussion included:  total symptom burden (ρ =.325, p = .036); having health insurance that covers cost of medication (ρ =-.337, p = .033); fear of disease progression (ρ =.356, p = .021); lack of clinician communication (ρ =.338, p = .028); and difficulty with multiple symptoms (ρ =.364, p = .018).

Conclusion: Patients with ovarian cancer discuss less than half of their symptoms with their clinician and a majority of those discussions are initiated by the patient. Commonly identified attitudinal barriers to symptom management are associated with lower rates of symptom discussion but higher rates of patient initiation. Further research should explore this interesting paradox.