Editor: Deborah Sesok-Pizzini, MD, MBA, professor, Department of Clinical Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, and chief, Division of Transfusion Medicine, Children’s Hospital of Philadelphia.
The patient-pathologist consultation program: a study of cancer patients
June 2020—More than 1.7 million new diagnoses of cancer occur in the United States each year, and they are almost exclusively made by pathologists who evaluate patient specimens and issue a written diagnostic report. These patients often are not given the opportunity to talk with the pathologist who made the diagnosis or view their tissue through a microscope. There is little published data on patient-pathologist consultation programs in which patients can review their reports and slides with the pathologist. In addition, the number of patients who may be interested in this service is not known. The authors conducted a study to quantify patients’ interest in patient-pathologist consultation programs and qualitatively analyze their motivations for interest or disinterest. They recruited study subjects from an academic cancer center and local community cancer support groups to measure their interest in such programs. The participants had the option of completing a survey using online forms posted on social media or paper cards. The investigators received 100 responses from the online survey and 42 from the identical paper version. The results showed that 75 percent of study subjects were interested in a patient-pathologist consultation program and seven percent had no interest. No association between gender or cancer type and interest level was found. However, there was a significant association between age and interest level, whereby increasing age was associated with decreased interest level. But when survey type (paper versus online) was added to the analysis, age was no longer a significant predictor. Survey type may be a confounder since many who filled out the paper survey were significantly older, and the majority of these participants were the same ones who were not interested in a consultation program. The major motivations for patients seeking pathologist consultations were a perception of empowerment from viewing the tissue and talking with a pathologist, interest in demystifying the process of a pathology diagnosis, and desire for enhanced understanding of their cancer. The authors concluded that there is a high level of interest in a patient-pathologist consultation program in a select group of cancer patients. Therefore, clinicians, pathologists, and hospital administrators should work together to pilot these programs in specific settings. The authors noted that additional work is needed to scale interventions for the interested population and to design the consultation programs and assess their value.
Lapedis CJ, Horowitz JK, Brown L, et al. The patient-pathologist consultation program: A mixed-methods study of interest and motivations in cancer patients. Arch Pathol Lab Med. 2020;144(4):490–496.
Correspondence: Dr. Cathryn J. Lapedis at cathrynb@med.umich.edu
An examination of advocacy education in residency training
Pathologists are central to the new health care environment and play key roles not only as the “doctor’s doctors” but also in genetic testing and personalized medicine. Pathologists are best suited to advocate for themselves and to convey the value they provide to patients, hospital administrators, political leaders, and payers. Advocacy education, a requirement of the Accreditation Council for Graduate Medical Education core program requirements and Milestones 2.0, is best introduced during residency. The authors conducted a two-pronged study to assess advocacy in residency training. They sent an electronic survey to 44 pathologists who graduated from residency programs between 2008 and 2017 to inquire about the leadership and advocacy opportunities available to them during training and after graduation. They also conducted a more focused email and telephone inquiry of 12 pathologists—four of whom were in practice for more than 20 years, four of whom were in practice less than 10 years, and four of whom were in postgraduate year four of residency training. The questions posed to the latter group focused on how they became involved in advocacy and which early experiences made the greatest impression on them. The study noted that advocacy efforts have increased through the years and that a greater number of national resident groups, which serve as training environments for advocacy efforts, are available than ever before. In addition, internal opportunities to shadow faculty during interdepartmental leadership meetings and during the process of selecting a chief resident continue to be enduring tools for honing leadership skills. Of interest, the study found that directly observing leadership interaction had a greater impact than leadership-oriented reading assignments. The authors concluded that advocacy education may require a combination of internal and external resources since advocacy training opportunities vary by program. Furthermore, shadowing during real advocacy situations made the most significant impression.
Black CC, Motta A. An examination of advocacy education in residency training. Arch Pathol Lab Med. 2020;144(4):497–499.
Correspondence: Dr. Candice C. Black at candice.c.black@hitchcock.org