Determining patient-oncologist cancer treatment intent concordance using systematic screening in a supportive care...

Accurate illness understanding is a necessary component of goal-concordant care. Few prior studies have investigated systematic screening for illness understanding. The objectives of this study were to determine the extent of agreement between patient-reported and oncologist-documented cancer treatment intent using systematic screening and to explore the association between such agreement and patient characteristics.

We implemented illness understanding screening for patients who presented to our supportive care center (SCC). We compared patient responses regarding chance of cure and primary treatment goal on a survey administered at their initial consultation visit with the oncologist-documented treatment intent in the electronic health record.

The analysis included 300 patients (mean age, 59 years); most were women (56%), were White (80.3%), and had advanced disease (78%). Regarding concordance, 152 (50.7%) patients had concordant treatment intent (cure, n = 64; non-cure, n = 88), and 148 (49.3%) patients had discordant treatment intent, with 98.6% (n = 146) of patients with discordant treatment intent inaccurately reporting a treatment intent of cure. Patients with discordant treatment intent were more likely to be Black (OR = 3.13, p = 0.02), have a primary cancer site of "other" (mostly melanoma and sarcoma) (OR = 2.30, p = 0.04), have advanced disease (OR = 6.25, p < 0.001), and report lower spiritual pain (OR = 0.88, p = 0.04).

The rate of inaccuracy in patient-reported curability perception and primary treatment goal at our SCC is high, supporting the need for systematic screening and communication interventions to improve illness understanding and provide goal-concordant care.