In a viewpoint article (published online on August 13, 2015 in JAMA Oncology), a medical student and two clinicians from the University of Michigan Medical School in Ann Arbor proposed that telemedicine can potentially relieve anxiety associated with waiting for in-person consultations. They used conveying biopsy results as an example of how a telemedicine encounter could be used to deliver bad news.
Because a positive biopsy result usually elicits shock and disbelief, the authors propose that if the bad news is delivered via telemedicine in advance of an in-person consultation, a more meaningful conversation about prognosis and treatment options would occur during the in-person visit. In addition, the telemedicine approach also gives the patient some time to process the results alone or with their family and support system.
The authors cite studies in which message content and timeliness were noted by patients as the most important factors when delivering bad news. A measure rating low in the studies was nonverbal support (eg, hand-holding). This makes sense since a visit establishing a cancer diagnosis is usually the first, or one of the first visits, the patient makes. There hasn’t been enough time or interaction to form a patient–physician bond. It appears that hand-holding and other nonverbal support are only helpful when a relationship exists between the physician and patient.
As telemedicine and other forms of technology are increasingly being used in healthcare, it’s likely that new ways of using this technology will be examined. In the example of relaying biopsy results, it appears that it is not only a cost-effective measure, but one that also better prepares the patient for a meaningful in-person discussion.
Krishnan N, Fagerlin, A, Skolarus TA. Rethinking patient-physician communication of biopsy results—the waiting game [published online before print August 13, 2015]. JAMA Oncology.