Exploring Trust Within the Patient-Oncologist Relationship
When Theresa Wittenberg, a PA, noticed that many of the patients who had neuroendocrine tumors (NETs) were struggling to establish trust in their physicians, she recommended her team take a closer look. First-year oncology fellow Eric Mou, MD, lead the charge and visited a community support group to have an open conversation with patients living with this uncommon type of cancer. The experience impacted him so much he came back to his colleagues and said, “This has to be part of the curriculum for every fellow.”
According to Pamela Kunz, MD, assistant professor of oncology, as told in this video, that’s how Mou came to write the now very popular commentary for the JAMA Oncology Series “Cancer Care Chronicles.” In “The Power of Trust,” to which Kunz and colleague Lidia Schapira, MD, associate profess of oncology, also contributed, Mou writes, “Research has shown that trust is inherently strong between patients and their oncologists, owing in part to patients’ belief in the competency of their physicians in treating life-threatening diseases. But how might this differ in those with rare cancers?”
The patients he spoke with in the community support group identified a major barrier to trust right away: physicians’ general knowledge deficits about NETs. One patient told him, “When you have to educate every physician that you meet, and you realize that you know more about your disease than they do, it makes it so difficult to build trust and confidence in the medical community.” It’s something patients with NETs encounter over and over. Mou writes, “Compared with patients with more common cancers, patients with NETs may find it more difficult to establish baseline levels of medical trust and harbor greater vulnerability to its erosion over time.”
Patients with NETs may find it more difficult to establish baseline levels of medical trust and harbor greater vulnerability to its erosion over time.
Their experience is the opposite of what Mou hoped for when he chose a career in oncology. He says he was inspired by “the solace [patients] found in the counsel and care of their oncologists,” but many patients with NETs, he says, “sought the same basic assistance from their physicians, only to be left to fend for themselves.”
Mou’s JAMA Oncology commentary offers new inspiration and motivation to oncologists. In an era of “precise diagnostics and novel treatment modalities,” Mou proposes and additional way to personalize cancer care: “As physicians, it is imperative that we understand that the inherent differences across the spectrum of malignant neoplasms we encounter should prompt us to tailor our care to each patient’s distinctive experience of their disease.”