Language and other strategies used to explain low-risk lesions
| Approach | Reported by patients | Reported by physicians |
| Language | ||
| Little to no explanation or other approach | She didn’t really explain how it could affect my health. (14 patient cervix) | – |
| Used plain/lay language | My doctor sat me down and, it’s not like dumbing down, but explained in laymen terms what the situation is. (06 patient bladder) | Most people, if you say ‘you have a cancer’, then they understand that. So, I will often say, this is not a cancer, this is the step before cancer. (20 gynecologic oncologist cervix) |
| Described treatment options to explain risk | I think the piece was that I heard cancer and you know this is the treatment path, this is what we’re going to do. (11 patient bladder) | – |
| Explained how common condition was | They were trying to explain that it was a common thing and that … cervical cancer is something that’s very easy to detect early on … like they’re trying to make you feel better about it and I think that does work. (13 patient cervix) | I’ll let them know that it’s actually quite common to have … that it will go back to normal. So that’s sort of reassuring to them. (17 family physician cervix) |
| Described risk of recurrence or chance of survival | He said we caught it probably 3 years earlier than it would have been caught if I hadn’t had my first surgery, and there was a chance that it will come back, and we would just track it for 5 or 6 years. (07 patient bladder) | I tend to use terms like 99% likelihood that you’re not gonna succumb to prostate cancer in the next 15 years. (25 urologist prostate) |
| Referred to staging, grade or continuum in relation to risk | (The doctor described risk) by indicating that Gleason 6 was the lowest diagnosis level and that it was contained in the prostate and that prostate cancer is recognized as a slow spreading cancer and that you didn’t have to jump to any conclusion or serious treatment. (02 patient prostate) | Sometimes, I do talk in fairly simple terms, grading things, Grade I, Grade II and Grade III, as levels of severity, using an old numeric system. I think grading it like that does help people understand it a little bit better. (20 gynecologic oncologist cervix) |
| Explicitly state low-risk lesions differ from invasive cancer | – | People will say, ‘do I have a cancer?’ And I always say, ‘no, it’s an abnormal cell in a smaller quantity.’ So I try to explain that way just to be sure that patient are not too worried or scared. (16 family physician bladder) |
| Used analogies | – | I’ll use analogies, like, your bladder tumor is only into the first layer of the bladder which is kind of like the lining of your cheek, so that they can understand that it’s just in the first layer. (23 urologic oncologist bladder) |
| Other | ||
| Took extra time to discuss concerns and answer questions | He then sent me out to go talk to my wife about it … I was still trying to process what he said …The positive is that he came out and … asked me ‘were you able to discuss this with your wife?’ He said, ‘come with me,’ and he then took us into his office to discuss it in more detail. (11 patient bladder) | After my explanation, … I ask them, ‘do you have any questions about that?’ and …most of my patients understand that very well. (16 family physician bladder) |
| Used visual aids | When I went there, she tried to show me picture of the cervix, which was close to normal, and another one, which was cancer, and the one, which was close to cancer. She tried to explain by showing me pictures. (15 patient cervix) | I also show pictures of the range of Gleason I to Gleason V and how their biopsy results were obtained. (22 radiation oncologist prostate) |
| Provided educational material | They gave me a few booklets about prostate cancer, about sexual life for people with prostate cancer, about some treatments which exist and are approved. (05 patient prostate) | There are also CUA brochures … I’ll usually give the patient one of those brochures and circle what’s going on with them. And I’ll say … these are accurate and the information is reliable; if you want to know more, I think that’s the best resource. (27 urologist bladder) |
| Used pathology or radiology report to supplement discussion | – | I would go through the pathology results identifying that there is this low-risk prostate cancer and how that determination was made from. (22 radiation oncologist prostate) |
| Asked patient to articulate specific concerns | – | What I’ll often do to understand what that patient’s concerns are, say ‘can you please tell me what you’re most worried about?’ (26 family physician cervix) |
| Arranged follow-up visit to discuss further | – | There is so much information going back and forth, and the patient, they just forget pretty much everything. Then I set up another follow-up in a few weeks to say, What do you want to do? Do you have any questions? (27 urologist bladder) |