PS 3-29 COMMUNICATION OF QUANTITATIVE INFORMATION AND UNCERTAINTY IN THE BREAST CANCER TREATMENT CONSULTATION

Tuesday, October 25, 2016
Bayshore Ballroom ABC, Lobby Level (Westin Bayshore Vancouver)
Poster Board # PS 3-29

Marilyn Schapira, MD, MPH1, Kathlyn Fletcher, MD, MA2, Pamela Ganschow, MD3, Elizabeth Jacobs, MD4, Cynthia M. Walker, Ph.D.5, Denisse Gil3, Alicia Smallwood2, Courtney Okwara6, Esther Nivasch, BA7, Arhshia Faghri8 and Joan Neuner, MD2, (1)University of Pennsylvania, Philadelphia, PA, (2)Milwaukee, WI, (3)John H. Stroger Hospital, Chicago, IL, (4)Madison, WI, (5)University of Wisconsin, Milwaukee, WI, (6)Harvard University, Cambridge, MA, (7)Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA, (8)Philadelphia, PA
Purpose: Numeric concepts are salient in cancer treatment consultations including discussions of survival, risk of recurrence, efficacy, and genomic testing.   We describe the domains, terms, complexity, and types of uncertainty used to communicate quantitative concepts in cancer treatment consultations as well communication techniques used to assess understanding. 

Method: Participants included English- and Spanish-speaking women with a new diagnosis of stage 0, 1, 2, or 3 breast cancer and their consulting clinicians (General Surgery, Radiation Oncology, and Medical Oncology).  Consultations were audio-recorded and transcribed verbatim; Spanish transcripts were translated to English for ease of coding.  Codes included numeric domains (number sense, tables/graphs, risk & probability, statistics and scientific evidence); categories of quantitative concepts including descriptive terms (i.e., high, low), nominal terms (i.e., Stage 2), whole numbers, percentages, decimals, fractions or proportions, and measurements; statistical and evidentiary uncertainty, and complex statements defined by two or more numeric categories or requiring a calculation.  Use of techniques to assess patient understanding (teach back or prompting for questions) were also coded.  We calculated the percent of consults that used each term (presented here) and the average frequency of use for each term per consult. 

Result: 31 consultations were analyzed (4 in Spanish).  The most commonly used numeric domains were number sense (100%), followed by risk and probability (94%), statistics (58%), and tables & graphs (6.5%).   Descriptive (100%) and nominal (68%) terms were often used to describe quantitative concepts. In comparison to whole numbers (100%), factions/proportions (77%), percentages (75%), or decimals (23%), were less commonly used.  Statistical and evidentiary uncertainty statements were included in 58% and 36% of consultations, respectively.   Complex information (multiple numeric term categories or requiring a mental calculation) were used in 77% and 55%, respectively.  For example, the statement “If you do the surgery, do the radiation, and do the Tamoxifen, the pill for a day for five years, you can get that 6% down to about 4-5%, so it’s not a big drop, by any means”, included both complex information and statistical uncertainty.  The teach back technique was used in 36% of consultations to assess understanding.   

Conclusion: This taxonomy of numeric terms provides a way to assess numeric demand of quantitative information in cancer communication and the potential to better align demand with the skill of individual patients.

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