Communication Frameworks for Palliative Surgical Consultations: A Randomized Study of Advanced Cancer Patients.

OBJECTIVE: To evaluate if patients with advanced cancer prefer surgeons to use the best case/worst case (BC/WC) communication framework over the traditional risk/benefit (R/B) framework in the context of palliative surgical scenarios.

BACKGROUND: Identifying patients' preferred communication frameworks may improve satisfaction and outcome measures during difficult clinical decision-making.

METHODS: In a video vignette-based randomized, double-blinded study from November 2020 to May 2021, patients with advanced cancer viewed two videos depicting a physician-patient encounter in a palliative surgical scenario in which the surgeon uses either the BC/WC or the R/B framework to discuss treatment options. The primary outcome was patients' preferred video surgeon.

RESULTS: 155 patients were approached to participate; 66 were randomized and 58 completed the study (mean age 55.8±13.8 y, 60.3% male). 22 patients (37.9%, 95%CI:25.4%-50.4%) preferred the surgeon using the BC/WC framework, 21 (36.2%, 95%CI:23.8%-48.6%) preferred the surgeon using the R/B framework, and 15 (25.9%, 95%CI:14.6%-37.2%) indicated no preference. A high trust in the medical profession was inversely associated with a preference for the surgeon using BC/WC framework (OR 0.83, 95%CI 0.70-0.98, P=0.03). The BC/WC framework rated higher for perceived surgeon's listening (4.6±0.7 vs. 4.3±0.9, P=0.03) and confidence in the surgeon's trustworthiness (4.3±0.8 vs. 4.0±0.9, P=0.04).

CONCLUSIONS: Surgeon use of the BC/WC communication framework was not universally preferred but was as acceptable to patients as the traditional R/B framework and rated higher in certain aspects of communication. A preference for a surgeon using BC/WC was associated with lower trust in the medical profession. Surgeons should consider the BC/WC framework to individualize their approach to challenging clinical discussions.