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

PURPOSE: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.