One of the ever-present challenges of being a physician is educating your patients in a way that is measured, easy to understand, and reassuring. The opposite end of the spectrum would be to give your patients incomplete information, request their compliance to medications without explaining what they do, and show a lack of empathy.
Most medical schools today recognize the importance of training soon-to-be doctors on how to talk to patients in a way that is professional and helpful. Medical students are required to learn—and to pass exams on—how to “break bad news,” for example. The logic behind this addition to the curriculum is simple: inappropriate and callous conversations with patients can result in serious damage. For example, a physician telling a patient flippantly that “he has cancer,” without taking into account the life-changing nature of that information, can cause psychological harm.
As medicine moves forward, we want the relationship between physician and patient to become more equal, with respect and empathy at its core. This is also beneficial in a way that may not seem immediately obvious: a strong physician-patient relationship invites compliance to medications and follow-ups. That translates to better care and a better prognosis.
Continue Reading
A Divide in Adherence
In this essay, we will be looking specifically at gastrointestinal stromal tumors (GIST) and patient adherence to imatinib. A team of Chinese researchers conducted a cross-sectional study examining adherence to adjuvant imatinib therapy in patients with GIST; we will explore some of their findings here.
The researchers wanted to study GIST patient adherence to adjuvant imatinib because there is little information concerning it in the existing medical literature. They recruited 158 patients who were seen at their GIST specialty clinic between March 2018 and September 2019. All of the patients recruited had received adjuvant imatinib at 400 mg daily for at least one month.
Wang et al assessed adherence using the 8-item Morisky Medication Adherence Scale (MMAS), which is mostly used for patients who are on medications for chronic illnesses. The scores range from 0 to 8; in this study, patients with scores of less than 8 were considered nonadherent, while patients with a score of 8 were classified as adherent.
Out of the 158 participants, 92 (58.2%) were classified as nonadherent. As expected, this had an effect on drug concentration: nonadherent patients had significantly lower plasma concentrations of imatinib, compared to adherent patients.
Read more about GIST etiology
The big question here is why more than half of the patients studied were nonadherent. Wang and colleagues offered up some explanations, including one on the urban-rural divide: “Consistent with prior reported findings of urban patients in other disease states demonstrating better adherence than rural patients, the present study found that the proportion of non-adherence in rural areas was significantly higher than in urban and suburban areas.”
And how do we explain these findings? Wang et al wrote, “One possible explanation might be that rural patients have poor beliefs related to medicine.” In other words, patient education was poorer in rural areas compared to urban areas. Interestingly, the researchers also discovered that “education and concomitant medications were significantly correlated with adherence.” If patients do not understand the significance of imatinib, why bother taking it?
Education for GIST Patients
It is clear, therefore, that patient education must be considered an integral part of any treatment plan. When a medication is prescribed, patients must be educated on its importance, how it is to be taken, and how frequently.
Read more about GIST patient education
In addition to educating patients about medications, what else should GIST patients know? Burch and Ahmad wrote a study on GIST, describing the disease in detail from its etiology to its prognosis. They devoted a section of their study to patient education. Based on their study, here are some points I believe are vital for every patient with GIST to know:
- GISTs are tumors that occur in the digestive tract.
- They commonly occur later in life, with the average age of diagnosis being 60.
- Signs and symptoms typically include abdominal pain, fullness, change in bowel habits, and blood in the stool (or black stool).
- A diagnosis is made based on biopsy results. Medical imaging, such as CT, MRI, or endoscopy can be helpful.
- Surgery is the preferred treatment method but is sometimes impossible if the tumor has grown in a way that makes it hard to be removed, or if it has metastasized.
- Tyrosine kinase inhibitors (such as imatinib) can sometimes be prescribed to shrink the size of the tumor to make it easier to be surgically removed.
- The same medication can be used post-surgery for high-risk GISTs.
- If surgery is not possible, tyrosine kinase inhibitors may be prescribed indefinitely in order to suppress tumor growth.
The emphasis here is not to make the patient a cancer expert, but to ensure the patient understands the gravity of the disease, its prognosis, and the treatment options available. One of the best ways to ensure the patient has fully understood what has been said is to ask the patient to repeat what he has understood, using his own words.
The goal of sound patient education is to secure patient adherence to medications prescribed and to give them a sense that cancer is a fight that is fought together—with both physician and patient included.
References
Wang Y, Zhang P, Han Y, et al. Adherence to adjuvant imatinib therapy in patients with gastrointestinal stromal tumor in clinical practice: A cross-sectional study. Chemotherapy. 2019;64(4):197-204. doi:10.1159/000505177
Burch J, Ahmad I. Gastrointestinal stromal cancer. In: StatPearls. StatPearls Publishing; 2021. Accessed December 10, 2021.
