Computer enhances doctor­patient relationship

CMAJ 1998;158:1003

© Jane Stewart

Breast cancer patients at a Winnipeg oncology clinic are testing a touch-screen computer program that helps them identify their information needs and the role they want to play during treatment.

"It's a low-dose intervention," comments Dr. Lesley Degner of the St. Boniface General Hospital Research Centre, who is principal investigator during a clinical trial of the system.

Approximately 280 patients have participated to date. The women are divided into 2 groups: members of 1 group use the computer and members of the other respond to the same questions but on paper. Those using the computer receive a printout. After seeing the doctor, both groups of patients are given a patient satisfaction questionnaire to ascertain the results of the visit. It determines whether the patient achieved her desired level of decision-making and whether she obtained the information she wanted.

Principal investigator Dr. Lesley Degner (standing) and research nurse Luella Sinha look on as patient Mary Barwinsky selects her role preferences by touching computer screen.

The researchers have determined that the process of identifying role preference and information needs has caused women to think more about these issues. "It solidifies [preferences] when women see the printout," said Degner.

Degner, a registered nurse, said there is little in the medical literature to indicate whether physicians ask patients about their information needs. This study not only will provide a breakdown on information needs and role preferences according to age but also will help document whether physicians are asking patients the right questions.

The study, funded by the Canadian Breast Cancer Research Initiative, follows 2 previous studies by Degner. The first assessed the information needs and treatment-participation choices of breast cancer patients. It found that about two-thirds of the 1012 women surveyed wanted to be involved in their treatment choices (Degner LF, Kristjanson LJ, Bowman D, Sloan JA, Carriere KC, O'Neil J, et al. Information needs and decisional preferences in women with breast cancer. JAMA 1997;277:1485-92). Less than half, however, believed they were able to participate to the degree they wished.

This sample printout shows the role the patient wants to play on the day of the visit. She wants to play a slightly stronger role in decision-making while still working closely with the physician.

In another study, Degner and colleagues monitored 278 breast cancer patients to find out if their information needs changed following their diagnosis. They also looked at the extent to which patient participation in treatment decisions predicted psychosocial outcomes such as anxiety, depression and regret about decisions. Results from this study are currently being analysed.

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