Evaluating Oncologists' Communication Strategies Regarding Molecular Testing and Immunotherapy

In metastatic colorectal cancer (mCRC), testing for mismatch repair deficiency (dMMR) can identify patients who will benefit from immune checkpoint inhibitors (ICIs). Communication regarding molecular testing and ICI is challenging, with studies demonstrating that oncologists have varied knowledge of genomic testing and frequently use technical jargon, and patient understanding is poor. We aimed to characterize discussions of molecular testing and ICIs to identify effective communication strategies.

We conducted an observational qualitative study from 2022 to 2023. We recruited US medical oncologists who treat colon cancer. Oncologists participated in recorded telehealth encounters with standardized patients with dMMR mCRC who were referred to discuss treatment. NVivo QSR 14 was used for transcription and code identification via content analysis.

The study included 107 oncologists at 42 institutions across 27 US states who were contacted via email, and 21 (20%) participated. The median age was 41 years, 43% were female, and 33% were non-White. Average encounter duration was 44 minutes 5 seconds. The conversation structure was similar, but descriptions differed. MMR was described using variable terms, most commonly mutation (8/21) and protein loss (8/21). Almost all (20/21) oncologists discussed ICI, and over half (11/20) explained the mechanism. A minority of oncologists (5/21) reported response rates to immunotherapy (30%-70%) and informed of severe side effects. Oncologists uncommonly discussed next-generation sequencing (6/21), while over half (13/21) discussed germline testing.

This nationwide sample of oncologists used variable descriptions when discussing MMR and ICI, as evidenced by the use of technical jargon and inconsistent inclusion of key topics, including the likelihood of response and severe adverse events. The use of a structured framework could help oncologists communicate key information to patients more effectively.