{"id":18089,"date":"2019-01-10T14:38:20","date_gmt":"2019-01-10T19:38:20","guid":{"rendered":"https:\/\/www.med.unc.edu\/medicine\/news\/chairs-corner\/podcasts\/dr-ethan-basch-patient-reported-outcomes-research\/"},"modified":"2023-06-06T14:04:13","modified_gmt":"2023-06-06T18:04:13","slug":"basch-research","status":"publish","type":"episode","link":"https:\/\/www.med.unc.edu\/medicine\/news\/chairs-corner\/podcast\/basch-research\/","title":{"rendered":"Dr. Ethan Basch &amp; Patient-Reported Outcomes Research"},"content":{"rendered":"<p><!-- description --><\/p>\n<p class=\"lead\">What are the challenges that patients face in communicating with their physicians, and how do questionnaires work to help? Dr. Ron Falk interviews Dr. Ethan Basch in this podcast about patient-reported outcomes research. Dr. Basch is a Professor of Medicine in the Division of Hematology and Oncology at UNC, and a Professor of Health Policy and Management in the School of Public Health. He is the Director of the UNC Cancer Outcomes Research Program, and serves as an Associate Editor for the Journal of the American Medical Association.<\/p>\n<!--[if lt IE 9]><script>document.createElement('audio');<\/script><![endif]-->\n\t<div class=\"wp-playlist wp-audio-playlist wp-playlist-light\">\n\t\t\t<div class=\"wp-playlist-current-item\"><\/div>\n\t\t<audio controls=\"controls\" preload=\"none\" width=\"1118\"\n\t\t\t><\/audio>\n\t<div class=\"wp-playlist-next\"><\/div>\n\t<div class=\"wp-playlist-prev\"><\/div>\n\t<noscript>\n\t<ol>\n\t\t<li><a class=\"thumbnail img-thumbnail\" href='https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2019\/03\/basch-research.mp3'>Full-Length Track<\/a><\/li><li><a class=\"thumbnail img-thumbnail\" href='https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2019\/01\/basch-outcomes.mp3'>What is a patient-reported outcome?<\/a><\/li><li><a class=\"thumbnail img-thumbnail\" href='https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2019\/01\/basch-challenges.mp3'>Challenges patients face communicating with their physician<\/a><\/li><li><a class=\"thumbnail img-thumbnail\" href='https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2019\/01\/basch-whatworks.mp3'>What works to engage patients<\/a><\/li><li><a class=\"thumbnail img-thumbnail\" href='https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2019\/01\/basch-time.mp3'>How physicians have time for this<\/a><\/li><li><a class=\"thumbnail img-thumbnail\" href='https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2019\/01\/basch-patients.mp3'>Applying the research to patient care<\/a><\/li><li><a class=\"thumbnail img-thumbnail\" href='https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2019\/01\/basch-delicate.mp3'>Discussing delicate topics with patients<\/a><\/li><li><a class=\"thumbnail img-thumbnail\" href='https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2019\/01\/basch-questionnaires.mp3'>Questionnaires for caregivers<\/a><\/li><li><a class=\"thumbnail img-thumbnail\" href='https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2019\/01\/basch-prostate-cancer-questions.mp3'>Common questions about prostate cancer & treatment<\/a><\/li>\t<\/ol>\n\t<\/noscript>\n\t<script type=\"application\/json\" class=\"wp-playlist-script\">{\"type\":\"audio\",\"tracklist\":true,\"tracknumbers\":true,\"images\":true,\"artists\":true,\"tracks\":[{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/uploads\\\/sites\\\/945\\\/2019\\\/03\\\/basch-research.mp3\",\"type\":\"audio\\\/mpeg\",\"title\":\"Full-Length Track\",\"caption\":\"\",\"description\":\"\\\"basch-research\\\" from Dr. Ethan Basch &amp; Patient-Reported Outcomes Research by UNC Department of Medicine: Dr. Ron Falk. 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Released: 2019.\",\"meta\":{\"year\":\"2019\",\"length_formatted\":\"2:14\"},\"image\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64},\"thumb\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64}},{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/uploads\\\/sites\\\/945\\\/2019\\\/01\\\/basch-challenges.mp3\",\"type\":\"audio\\\/mpeg\",\"title\":\"Challenges patients face communicating with their physician\",\"caption\":\"\",\"description\":\"\\\"basch-challenges\\\". Released: 2019.\",\"meta\":{\"year\":\"2019\",\"length_formatted\":\"7:03\"},\"image\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64},\"thumb\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64}},{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/uploads\\\/sites\\\/945\\\/2019\\\/01\\\/basch-whatworks.mp3\",\"type\":\"audio\\\/mpeg\",\"title\":\"What works to engage patients\",\"caption\":\"\",\"description\":\"\\\"basch-whatworks\\\". Released: 2019.\",\"meta\":{\"year\":\"2019\",\"length_formatted\":\"2:23\"},\"image\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64},\"thumb\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64}},{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/uploads\\\/sites\\\/945\\\/2019\\\/01\\\/basch-time.mp3\",\"type\":\"audio\\\/mpeg\",\"title\":\"How physicians have time for this\",\"caption\":\"\",\"description\":\"\\\"basch-time\\\". Released: 2019.\",\"meta\":{\"year\":\"2019\",\"length_formatted\":\"1:38\"},\"image\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64},\"thumb\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64}},{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/uploads\\\/sites\\\/945\\\/2019\\\/01\\\/basch-patients.mp3\",\"type\":\"audio\\\/mpeg\",\"title\":\"Applying the research to patient care\",\"caption\":\"\",\"description\":\"\\\"basch-patients\\\". Released: 2019.\",\"meta\":{\"year\":\"2019\",\"length_formatted\":\"2:14\"},\"image\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64},\"thumb\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64}},{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/uploads\\\/sites\\\/945\\\/2019\\\/01\\\/basch-delicate.mp3\",\"type\":\"audio\\\/mpeg\",\"title\":\"Discussing delicate topics with patients\",\"caption\":\"\",\"description\":\"\\\"basch-delicate\\\". Released: 2019.\",\"meta\":{\"year\":\"2019\",\"length_formatted\":\"3:27\"},\"image\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64},\"thumb\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64}},{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/uploads\\\/sites\\\/945\\\/2019\\\/01\\\/basch-questionnaires.mp3\",\"type\":\"audio\\\/mpeg\",\"title\":\"Questionnaires for caregivers\",\"caption\":\"\",\"description\":\"\\\"basch-questionnaires\\\". Released: 2019.\",\"meta\":{\"year\":\"2019\",\"length_formatted\":\"1:18\"},\"image\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64},\"thumb\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64}},{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/uploads\\\/sites\\\/945\\\/2019\\\/01\\\/basch-prostate-cancer-questions.mp3\",\"type\":\"audio\\\/mpeg\",\"title\":\"Common questions about prostate cancer & treatment\",\"caption\":\"\",\"description\":\"\\\"basch-prostate-cancer-questions\\\". Released: 2019.\",\"meta\":{\"year\":\"2019\",\"length_formatted\":\"2:20\"},\"image\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64},\"thumb\":{\"src\":\"https:\\\/\\\/www.med.unc.edu\\\/medicine\\\/wp-content\\\/plugins\\\/media-library-assistant\\\/images\\\/crystal\\\/audio.png\",\"width\":48,\"height\":64}}]}<\/script>\n<\/div>\n\t\n<div class=\"image-section\">\n<figure class=\"thumbnail wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium\" src=\"https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2018\/12\/basch-research-image2.jpeg\" alt=\"image2\" width=\"300\" height=\"200\" \/><figcaption class=\"caption wp-caption-text\">Ethan Basch, MD<\/figcaption><\/figure>\n<\/div>\n<h4>&#8220;These very simple tools \u2013 electronic questionnaires that allow patients to tell us how they\u2019re doing &#8211; have actually had a remarkable impact on our ability to communicate with patients, to control symptoms, to reduce emergency room visits, hospitalizations, and in fact, in oncology, it turns out that people live longer when they are given simple questionnaires between visits to communicate with their doctors.&#8221;<\/h4>\n<h4>-Dr. Basch<\/h4>\n<p><b>Falk:<\/b> Hello, this is Ron Falk for the Department of Medicine at the University of North Carolina. Welcome to the Chair\u2019s Corner.<\/p>\n<p>Today we welcome Dr. Ethan Basch who is a Professor of Medicine in our Division of Hematology and Oncology at UNC, and he also holds an appointment as Professor of Health Policy and Management in the School of Public Health.<\/p>\n<p>Dr. Basch, amongst a number of wonderful things that he does, is the Director of the UNC Cancer Outcomes Research Program, and he serves as an Associate Editor for <i>the Journal of the American Medical Association<\/i>, <i>JAMA<\/i>, and has numerous other leadership roles on national committees and programs, which we will discuss later in our program.<\/p>\n<p>Welcome, Dr. Basch.<\/p>\n<p><b>Basch: <\/b>Thanks. It\u2019s very nice to be here.<\/p>\n<p><b>Falk:<\/b> You are a cancer doctor\u2014you are an oncologist, and you take care of people with cancer, specifically prostate cancer, but what you really have made your name in, is this whole sphere of patient-reported outcome measures. What on earth is a patient-reported outcome and why would I want to know about that?<\/p>\n<p><b>Basch: <\/b>Sure, and thank you for the nice introduction. It\u2019s a great question. A patient-reported outcome simply is something that a patient tells either to a health care provider or a researcher, about how they\u2019re feeling or functioning. Essentially a symptom or how they\u2019re physically functioning. That\u2019s generally done through simple questionnaires. Now this sounds like a very simple concept. We all fill out surveys and questionnaires all the time. We get them in the mail, we get them by telephone, and by computer, but in fact in health care, historically, and unfortunately, we\u2019ve not done a very good job getting information from our patients about how they\u2019re feeling or functioning. For example, a patient might come to see me the office, I might meet with them for twenty or thirty minutes, and then, until I see them the next time, they spend more than ninety-nine percent of their time out of sight and out of mind. And we don\u2019t have really effective mechanisms for being in touch with our patients and knowing how they\u2019re doing. Certainly a patient could pick up the telephone and call us. Sometimes our electronic health record systems have a portal, but we know that most people don\u2019t take advantage of this.<\/p>\n<p>In fact, I saw a patient just yesterday in clinic who received chemotherapy and felt terribly\u2014was in bed much of the time, had a lot of symptoms, and came back to see me three weeks later, and I said to my patient, \u201cWhy didn\u2019t you call? It\u2019s my job. I\u2019d like to know. I could have helped.\u201d He said, \u201cWell, I didn\u2019t want to bother you.\u201d I think, unfortunately, this is often the situation. Either it\u2019s too cumbersome, or too challenging, or there\u2019s some sort of block to communicate with us, frankly it\u2019s not easy to communicate with us. So these very simple tools \u2013 electronic questionnaires that allow patients to tell us how they\u2019re doing, have actually had a remarkable impact on our ability to communicate with patients, to control symptoms, to reduce emergency room visits, hospitalizations, and in fact, in oncology, it turns out, that people live longer when they are given simple questionnaires between visits to communicate with their doctors.<\/p>\n<p>&#8230;<\/p>\n<p><i>Transcript continues below. See individual tabs to jump to specific topics.<\/i><\/p>\n<div id=\"accordion2\" class=\"accordion\">\n<div class=\"accordion-group\">\n<div class=\"accordion-heading\"><a class=\"accordion-toggle\" href=\"#collapseOne\" data-toggle=\"collapse\" data-parent=\"#accordion2\">Challenges patients face communicating with their physician<\/a><\/div>\n<div id=\"collapseOne\" class=\"accordion-body collapse\">\n<div class=\"accordion-inner\">\n<p><strong>Falk:<\/strong> Because there is this sense that patients disappear, that everything must be okay, because you haven\u2019t heard from them, and thus all is okay. But in reality, in a lot of conditions, not just in cancer, those assumptions are not valid. UNC and many other institutions try to have that dialogue. UNC has \u201cMy UNC Chart.\u201d Why doesn\u2019t that work? Or does it work to a certain extent, or does it really only work in certain populations?<\/p>\n<p><strong>Basch:<\/strong> It does work, to a certain extent. My Chart is essentially a patient-facing part of the electronic health record system. We all as physicians and nurses use an electronic health record system to keep track of information about patients, and there is a component of that that allows patients to see their own laboratory reports, to make appointments, and to send messages. These systems do have some rudimentary questionnaire functions, but they really are very rudimentary. We know that unfortunately, the vast minority of patients actually sign up for what are called patient portals. I think we\u2019re at the beginning \u2013 I think they\u2019re getting better, and they will become easier for patients. It will be important to meet patients where they live. For example, if I want to do a transaction from my bank account I can do it through my phone, through the web, over the telephone, so we need that kind of flexibility to meet people where they live and how they live their lives.<\/p>\n<p>The research that I\u2019m engaged with is essentially informing how patient portals like My Chart should work in the future, so that we can reach more people and be more effective.<\/p>\n<p><strong>Falk: <\/strong>Especially in this era where everybody is on some sort of social media, even folks of my generation text and e-mail, some Face Book, but it doesn\u2019t work as well with the medical profession. That translation of those tools to patient care seems to have lagged. Why? It\u2019s a big industry.<\/p>\n<p><strong>Basch: <\/strong>You\u2019re absolutely right. One important point from your statement is that people exchange information about how they\u2019re feeling all the time. They exchange information about the side effects from their medications. They exchange information about the symptoms of their disease. And we miss that. We\u2019re not capturing that. It\u2019s a major loss, because we could use that information to understand the effectiveness of drugs and other treatments, we could use that to help manage patients, we could use that information to understand quality of care. So it\u2019s a major missed opportunity. I think it\u2019s because, in many ways this aspect of medicine, like many aspects of medicine, don\u2019t start with the patient in mind. They start with the provider and the institution in mind. We have built hospitals to the convenience of physicians, right? I have a schedule for my clinic and patients must fit into my schedule, and if patients want to reach me they must call my office. We\u2019re not patient-centered.<\/p>\n<p><strong>Falk: <\/strong>The airline industry has completely revamped that. You can not only get a reservation online, you can pick your seat online. You can\u2019t do that in all places in the health care system. Is that what you\u2019re suggesting, that a patient should, if they want to come to see you, have some sort of ease in getting an appointment, but even more importantly, an ease in actually being able to interact with you? Is that what you\u2019re suggesting?<\/p>\n<p><strong>Basch: <\/strong>Yes, I think that\u2019s right. The ATM is a nice example of this. I remember as a child my father lining up on Friday at the bank. That was a great inconvenience, and a simple change like an automatic teller and interoperability between banks really changed this dramatically. I think we\u2019re seeing this more and more in health care. We\u2019re becoming patient-centered, we\u2019re thinking about the patient\u2019s home context and how they live their lives, and real-time and non-real-time means of communication. But we\u2019re really not there yet. So unfortunately, as we sit here today, we both have patients who are out of sight and out of mind, and they may in fact be suffering. That may have very substantial downstream consequences.<\/p>\n<p><strong>Falk: <\/strong>So for a patient, the ability to interact on their terms, would be tremendously beneficial. It would also be beneficial if there was some rudimentary kinds of measures that you could get in the home. You\u2019re working on some of those measures right now. One could imagine weight and blood pressure are physical characteristics that one could ask for, but your questionnaires are trying to, in a structured fashion, probe how the patient is feeling. Am I getting that right?<\/p>\n<p><strong>Basch: <\/strong>Yes, that\u2019s absolutely right. So I run a research program that has been investigating this area for about fifteen years now. We\u2019ve developed multiple questionnaire systems, several for national organizations like the National Cancer Institute or the main Oncology Professional Society. We\u2019ve developed technology platforms, but most of all we have explored the different kinds of work flows \u2013 the ways to integrate these into people\u2019s lives\u2014patients\u2019 lives and the ways to integrate these into busy clinician\u2019s lives. We\u2019ve found a number of things. In early research we found that clinicians miss about half of the symptoms that their patients have.<\/p>\n<p><strong>Falk: <\/strong>Just half?<\/p>\n<p><strong>Basch: <\/strong>Yes, well for some things it\u2019s more. Your statement is telling. We as clinicians recognize this. We know that this is a problem. Much of the early work that I was involved with was actually around clinical research, drug development and oncology. That was because when we developed new drugs in oncology, they\u2019re often very toxic. They have a lot of serious side effects, and because of this phenomenon that we\u2019ve been talking about, the missing of people\u2019s symptoms, missing their functional problems. When we\u2019ve developed drugs we\u2019ve had huge underestimates of the negative impact on people, so that when regulatory authorities like the FDA look at the profiles of these drugs, or devices that are coming through, we underestimate the toxicities or adverse events related to them. Much of our work has been to improve drug development to get a better understanding of the patient experience.<\/p>\n<p>More recently, we\u2019ve turned our attention to delivery of care and figuring out how to integrate this into how we take care of people every day.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"accordion-group\">\n<div class=\"accordion-heading\"><a class=\"accordion-toggle\" href=\"#collapseTwo\" data-toggle=\"collapse\" data-parent=\"#accordion2\">What works to engage patients<\/a><\/div>\n<div id=\"collapseTwo\" class=\"accordion-body collapse\">\n<div class=\"accordion-inner\">\n<p><strong>Falk:<\/strong> What have you found out about what works, and what doesn\u2019t work as well?<\/p>\n<p><strong>Basch: <\/strong>A few things. The first challenge is engaging people to understand that this is important, this is worth their time, and that this information will be used. We found that generally people will be enthusiastic to provide this information if they know that their doctor or their nurse want the information and that they\u2019ll use the information. If they find that nobody is paying any attention to this, they quickly lose interest. And in fact that\u2019s annoying. I personally would be annoyed by that as well. In general when we have spoken to patients, and we\u2019ve spoken to many, many patients from all different kinds of backgrounds, we have found that people are very enthusiastic. For the most part, these are people who have chronic conditions. They have heart failure, or pulmonary diseases, or cancer\u2014people who have ongoing problems, ongoing symptoms. This doesn\u2019t really apply to people who are well and see the doctor once a year. It\u2019s people who are already very engaged with the health care system and understand that their symptoms are important.<\/p>\n<p>We have found that in clinical research, about ninety-five percent of the time people will provide this information, and in clinical practice about eighty-five percent. Most notably what we found, is that in clinical trials, when we collect this information from patients, we greatly enhance the data that we have, we improve the precision of the data that we have, and the clinical investigators consistently feed back\u2014those are the people doing the research&#8211;that this information has actually changed their decision making about how the drug is given, how it\u2019s dosed, and how to recommend the use of the drug. And it\u2019s changed drug labels, the actual way that the FDA is labeling the drugs.<\/p>\n<p>In routine care, what we found, is that, again, patients who were enthusiastic about this, clinicians use and are also very positive about the information. As I alluded to earlier, when we integrate these patient-reported questionnaires into practice, symptom management improves, patient\u2019s quality of life improves, communication with providers improves, patient satisfaction improves, emergency room visits significantly go down, and in the case of people with advanced cancers, they actually live longer, because their symptoms are better controlled.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"accordion-group\">\n<div class=\"accordion-heading\"><a class=\"accordion-toggle\" href=\"#collapseThree\" data-toggle=\"collapse\" data-parent=\"#accordion2\">How physicians make the time for this<\/a><\/div>\n<div id=\"collapseThree\" class=\"accordion-body collapse\">\n<div class=\"accordion-inner\">\n<p><strong>Falk: <\/strong>How do you as a practicing physician have the time to be able to read or assimilate in one way or the other all of this information? How do you make it so that on days when you\u2019re not actually seeing that patient, you have the opportunity to have captured time to listen to these very important thoughts?<\/p>\n<p><strong>Basch: <\/strong>It\u2019s a great question, because there are many potential criticisms or many criticisms or comments one can receive on this, but one of them is, doctors and nurses are already so busy\u2014how can you burden them further with more information? There will be an onslaught of information and it will be overwhelming. I think I have a couple of answers to that. The first is that, again I come back to this patient-centered piece. In orientation or a filter by which we say, we can\u2019t overburden our doctors and nurses with this information\u2014is a very doctor-nurse-centered way of thinking\u2014it\u2019s not patient-centered, because our patients are at home with symptoms and it\u2019s our job to manage those symptoms. The second answer is that this is already part of what we do. Symptom management is a major part of my job as an oncologist. The third part, is that the research that we have done has actually demonstrated that this is not a major burden. There is actually not a lot of added time for doing this. In fact, it ultimately saves time because we avoid bad downstream consequences that we\u2019ve avoided by catching symptoms earlier.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"accordion-group\">\n<div class=\"accordion-heading\"><a class=\"accordion-toggle\" href=\"#collapseFour\" data-toggle=\"collapse\" data-parent=\"#accordion2\">Applying the research to patient care<\/a><\/div>\n<div id=\"collapseFour\" class=\"accordion-body collapse\">\n<div class=\"accordion-inner\">\n<p><strong>Falk: <\/strong>You specialize in prostate cancer. How have you applied the things you\u2019ve learned to caring for older males with prostate disease? Prostate cancer in particular?<\/p>\n<p><strong>Basch: <\/strong>In my own practice, I\u2019ve applied some of these principles in a number of ways. The first is that we have actually used some of these tools that we\u2019ve been talking about, and that helps these populations to have a better handle on how people are feeling between visits and are very effective for communication, so that when a patient comes into the clinic and sees one of us, rather than starting at the beginning and screening and talking about all of their symptoms, we can say \u201c<i>Mr. Smith, I see here from your form that since I saw you last you\u2019ve been having worsening pain and worsening nausea. I also see that you\u2019ve been trying the following measures for it. Tell me, how\u2019s that going?<\/i>\u201d That jumps us far ahead and makes our encounter more efficient.<\/p>\n<p>A second way, and I think myself as a provider, I have tried to focus more on how people are feeling, realizing that we miss so much of how people are feeling, so I really try to engage. A third way is I work closely with a nurse navigator. There\u2019s a lot of interest nationally in nurses who focus on how people are doing at home. The nurse navigator I work with has very close interaction with the patients in my practice both at and between visits, to make sure that they understand the various components of their treatment, and that we understand how they\u2019re doing.<\/p>\n<p><strong>Falk: <\/strong>Translating it, in other words. Translating what you\u2019ve said, or just another set of ears to listen to what the patient is trying to say?<\/p>\n<p><strong>Basch: <\/strong>I think it\u2019s both. For example, sometimes results of tests are mailed to patients at home. Those results are in my language, not in their language. It\u2019s often very difficult to decipher the meaning of that, and simply having somebody available to talk to patients about that can be very useful. But to your point, there\u2019s a translation about how patients are experiencing their home life to us in the clinic, where we wouldn\u2019t otherwise be aware of that.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"accordion-group\">\n<div class=\"accordion-heading\"><a class=\"accordion-toggle\" href=\"#collapseFive\" data-toggle=\"collapse\" data-parent=\"#accordion2\">Discussing delicate topics with patients<\/a><\/div>\n<div id=\"collapseFive\" class=\"accordion-body collapse\">\n<div class=\"accordion-inner\">\n<p><strong>Falk:<\/strong> In the prostate cancer world, as in many aspects of medicine, there can be a divergence between \u201c<i>You\u2019ve been cured of your disease, but your health has not been restored.<\/i>\u201d In other words, your cancer is gone, but either therapy or psychological adaptation have not been as effective, and the patient\u2019s health is not back to where it was before the cancer therapy\u2014chemotherapy, or radiation therapy was initiated. What have you learned to help us understand how patients perceive, \u201c<i>I\u2019ve been cured of my prostate cancer, but because of the therapy I no longer can have sex.<\/i>\u201d How does your research help with that?<\/p>\n<p><strong>Basch: <\/strong>That is a real challenge, and not just in oncology but in other contexts. In oncology there are many patients either who are cured or who are living with their cancer for a very long period of time who have many sequelae or consequences of this treatment. In the case of prostate cancer, following surgery or radiation, men may be left with urinary problems and with sexual function problems their whole life as well as fear of recurrence, and other psychosocial challenges.<\/p>\n<p>One of the benefits of the kind of research I\u2019m describing is simply to understand problems that exist among many men and to acknowledge them. For years in prostate cancer, we didn\u2019t acknowledge this, we sort of brushed it under the carpet and this was a problem for a couple of reasons. One, men who were living with this weren\u2019t acknowledged and they sort of suffered in silence. As a result it wasn\u2019t talked about, and people couldn\u2019t seek help or counseling. There are medical interventions to help people, for example, with erectile problems.<\/p>\n<p>But the second reason is that we were not able to adequately prepare men undergoing these procedures for what they might expect. We weren\u2019t able to say, \u201c<i>For the kind of disease that you have, and the kind of procedure you\u2019re going to have, men like you experience moderate urinary problems about a third of the time,by which I mean they had some staining or dribbling on their underwear, or some incontinence when coughing, etc.<\/i>\u201d This kind of research just makes us more aware so that we can communicate with patients and try to address their problems better.<\/p>\n<p><strong>Falk: <\/strong>Men have difficulty sometimes being able to be in touch with their emotions, let alone being able to express them. Do these questionnaires, does the ability to self-report, permit men to be more honest with these feelings and thus communicate them to you, rather than respond to a direct question that you may ask?<\/p>\n<p><strong>Basch: <\/strong>That\u2019s a terrific question. In fact, there is research demonstrating that, particularly when it comes to delicate topics like sexual function, men and women both are far more likely to report this information to a questionnaire than they will to a human, including their doctor or nurse. This actually enables us to unroof problems we wouldn\u2019t otherwise know about.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"accordion-group\">\n<div class=\"accordion-heading\"><a class=\"accordion-toggle\" href=\"#collapseSix\" data-toggle=\"collapse\" data-parent=\"#accordion2\">Questionnaires for caregivers<\/a><\/div>\n<div id=\"collapseSix\" class=\"accordion-body collapse\">\n<div class=\"accordion-inner\">\n<p><strong>Falk: <\/strong>Do you provide these questionnaires to the patient, and at what point do you provide questionnaires to a significant other who may be accompanying the patient on the visit?<\/p>\n<p><strong>Basch: <\/strong>There are all different ways that this is done, in various contexts. For the most part, the questionnaire does go to the patient. However, we know from much of the research that we and others have done is often times the patient brings a team. We know from observing people and questions in the questionnaire, say a man in the practice would be answering, and his wife or child would be elbowing them, saying \u201c<i>Come on, Dad, that\u2019s not really how it is,<\/i>\u201d \u2013 so there\u2019s a lot of input. In general we haven\u2019t really handed out questionnaires to caregivers on a routine basis. The truth is the caregivers go through an incredibly challenging experience when it\u2019s a patient with a chronic illness, and being more in touch with the caregivers, as they say, providing care to the care giver, is really essential. We could probably achieve that through questionnaires- it\u2019s a great idea for future research.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"accordion-group\">\n<div class=\"accordion-heading\"><a class=\"accordion-toggle\" href=\"#collapseSeven\" data-toggle=\"collapse\" data-parent=\"#accordion2\">Common questions about prostate cancer &amp; treatment<\/a><\/div>\n<div id=\"collapseSeven\" class=\"accordion-body collapse\">\n<div class=\"accordion-inner\">\n<p><strong>Falk:<\/strong> Tell me what the questions are that men most typically ask you, men with prostate cancer. What are the top 5 questions that are asked?<\/p>\n<p><strong>Basch: <\/strong>I\u2019m an oncologist, so I often see men who unfortunately have a cancer that has come back or can\u2019t be cured. Men want to know things like, what kind of symptoms can I expect to have? How long can I expect to live? People want to know about the side effects of the medications. They want to understand what they\u2019ll still be able to do. What will their strength be like, and can they continue with their activities? People also want to know if they need to make any behavior modifications, to change their diet, or their exercise, are there any herbs or supplements they can take. Those are the kinds of things that people generally ask about.<\/p>\n<p><strong>Falk: <\/strong>Are there new and exciting therapeutic options for prostate cancer patients?<\/p>\n<p><strong>Basch: <\/strong>There are a number of very effective new therapies in the medical oncology field, among people who have advanced prostate cancers that have come into use very recently. These are advanced hormonal types of therapies. One is called Abiraterone acetate and one is Enzalutamide. What\u2019s exciting about these medicines is first they\u2019re pills, they\u2019re not intravenous, so people can take them at home. The second very exciting component about them is they have very few side effects \u2013 which we know, because we have administered patient-reported outcome questionnaires to people, to understand that people can actually live their lives without a lot of toxicity which is pretty different from the traditional chemotherapies that we had, which caused quite a bit of toxicity. This is very exciting. There are also exciting, new radiotherapy types of approaches, in which we give these very small molecules to people and they emit a tiny burst of radiation called Alpha particles, right at the site where the cancer is when it goes to the bone. This is called Radium 223.<\/p>\n<p>Immunotherapies have been very interesting across oncology in general, but unfortunately have not seemed to have the same kind of effect on prostate cancer that we\u2019ve seen in other cancers.<\/p>\n<p><strong>Falk:<\/strong> Fascinating. Thank you once again for spending time with me today, and thanks so much for all you do.<\/p>\n<p><strong>Basch:<\/strong> Thank you very much, and likewise.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<p><span style=\"line-height: 1.43em\">*<\/span><\/p>\n<div class=\"alert alert-blue width:100% \">\n<p><strong>Visit these sites for more information related to this podcast conversation:<\/strong><\/p>\n<ul>\n<li><strong>Dr. Basch&#8217;s profiles on the <a class=\"external-link\" title=\"\" href=\"http:\/\/sph.unc.edu\/adv_profile\/ethan-basch-md-msc\" target=\"_blank\" rel=\"noopener\">UNC School of Public Health<\/a> and on <a class=\"external-link\" title=\"\" href=\"https:\/\/unclineberger.org\/people\/ethan-basch\" target=\"_blank\" rel=\"noopener\">UNC Lineberger<\/a><\/strong><\/li>\n<li><strong><a class=\"external-link\" title=\"\" href=\"https:\/\/unclineberger.org\/outcomes\" target=\"_blank\" rel=\"noopener\">UNC Cancer Outcomes Research Program<\/a><\/strong><\/li>\n<li><strong><a class=\"external-link\" title=\"\" href=\"https:\/\/unclineberger.org\/news\/outcomes-grant\" target=\"_blank\" rel=\"noopener\">UNC Lineberger news story<\/a> on five-year, $5.45 million grant awarded to Dr. Basch to study patient-reported outcomes<\/strong><\/li>\n<\/ul>\n<\/div>\n<p>\/\/ <\/p>\n","protected":false},"excerpt":{"rendered":"<p><!-- description --> <\/p>\n<p class='lead'>What are the challenges that patients face in communicating with their physicians, and how do questionnaires work to help? Dr. Ron Falk interviews Dr. Ethan Basch in this podcast about patient-reported outcomes research. Dr. Basch is a Professor of Medicine in the Division of Hematology and Oncology at UNC, and a Professor of Health Policy and Management in the School of Public Health. He is the Director of the UNC Cancer Outcomes Research Program, and serves as an Associate Editor for the Journal of the American Medical Association.<\/p>\n","protected":false},"featured_media":0,"menu_order":0,"template":"","meta":{"_acf_changed":false,"layout":"","cellInformation":"","apiCallInformation":"","_links_to":"","_links_to_target":""},"podcast-category":[639],"class_list":["post-18089","episode","type-episode","status-publish","hentry","podcast-category-podcast","odd"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Dr. Ethan Basch &amp; Patient-Reported Outcomes Research | Department of Medicine<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.med.unc.edu\/medicine\/news\/\/news\/chairs-corner\/podcast\/basch-research\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Dr. Ethan Basch &amp; Patient-Reported Outcomes Research | Department of Medicine\" \/>\n<meta property=\"og:description\" content=\"What are the challenges that patients face in communicating with their physicians, and how do questionnaires work to help? Dr. Ron Falk interviews Dr. Ethan Basch in this podcast about patient-reported outcomes research. Dr. Basch is a Professor of Medicine in the Division of Hematology and Oncology at UNC, and a Professor of Health Policy and Management in the School of Public Health. 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