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Cancer Trends: Patient Power

Q&A with Dr. Lalan Wilfong, Medical Oncologist, Texas Oncology–Presbyterian Cancer Center Dallas

How does Texas Oncology involve patients in the decision-making process while planning treatment?
Texas Oncology is taking steps to improve patient participation in decision making for their cancer care. We developed a treatment plan that all patients receive before starting any new cancer treatment. The plan covers important patient issues including the type and stage of cancer, the purpose and goal of treatment, and information on drugs and any side effects. Patients take the form home with them to discuss and share with family and friends. Having information upfront helps patients align their treatment decisions with their goals and values.

We try to have a one-on-one patient care coordination visit with an advanced practice provider before a patient starts chemotherapy. That visit helps the patient better understand and retain more knowledge about potential side effects and how their chemotherapy will work.

We also conduct a patient goals and values assessment. We ask patients what's important to them, which helps physicians better align treatment with patient wishes. For example, I had two patients with identical forms of breast cancer, but with completely different goals. One patient's main goal was remaining independent, while the second patient's priority was comfort. Consequently, we gave pain medicine to the patient who prioritized comfort and minimized pain medicine for the patient who valued independence. We care for patients based on what's important to them rather than just treating the cancer.

What are benefits for well-informed patients?
Well-informed patients are better able to discuss their care and related issues. Informed patients better understand medication compliance, potential side effects, and when to call us. One of our main goals is to keep patients out of the hospital and ER, and through education, we've seen a noticeable improvement. Patients are becoming more active in their cancer care. Baby Boomers and succeeding generations have more access to information and tend to question and conduct their own research more than previous generations.

I had two patients with identical forms of breast cancer with completely different goals. We gave pain medicine to the patient who prioritized comfort and minimized pain medicine for the patient who valued independence. We care for patients based on what’s important to them rather than just treating the cancer." Lalan Wilfong, M.D., Medical Oncologist
Texas Oncology–Presbyterian Cancer Center Dallas

How does having a better-educated patient impact friends and family?
Education and the written treatment plan help patients provide accurate information to friends and family. As part of the education process, we provide a Patient Care Guide that patients can share with family. The guide contains important information for caregivers about how they can help cancer patients. We want patients to involve friends and family members, because we know that cancer requires a lot of support from other people.

Do physicians want patients to discuss research they found on the Internet or from other sources?
Physicians want patients to receive accurate information. The Internet helps facilitate more informed and involved patients – especially when they're using trusted and vetted websites. We want patients to ask questions, to know what treatment they're getting, and to understand why.

How should patients approach a conversation with their physicians about their wishes?
It's important for patients to discuss their wishes with their doctor. Ideally, that discussion should occur both very early in the treatment and periodically throughout the treatment process. As cancers change, people and their goals and values can also change. We encourage patients to let us know how they're doing, because those discussions do improve care.