Remembering What the Doctor Said — Does Age Matter?

When patients see a cancer doctor for the first time, they don’t remember everything the doctor tells them.  In fact, both older patients and younger ones remembered about half what they heard about their diagnoses, treatment, chances for cure, and life expectancy.

Patients over 65 only remembered less than younger ones in those situations where visits were longer and more information was discussed.

Prognosis did make a difference.  Patients with poorer prognosis recalled less, no matter what age they were.  And, despite whether the expected cancer outcomes were good or not, the more a doctor talked about prognosis, the less patients remembered.

Researchers in Australia got permission to tape initial visits to medical or radiation oncologists. They measured the length of the visit, the number of questions patients asked, and the amount of information the doctor gave about the patient’s diagnosis, treatment recommendations, and chances of cure and life expectancy (prognosis.) Later they telephoned patients to find out how many details of the visit the patient remembered.

Before the visit, patients were asked how much information they want to hear from the doctor.  There was no difference between younger and older patients about either the amount of information they wanted or the details.  Ninety percent of both patients under 65 and those older wanted to hear all the information about diagnosis, treatment, and prognosis.  More than eighty percent wanted all the details.

Younger patients asked more questions during their visits, but there was no difference in the percentage of input younger or older patients had during the consultation.  Both contributed about 40 percent to interactions between doctor and patient.

Telephone interviews revealed:

  • Younger patients recalled 49.5 percent of what they heard during the visit, patients 65 and older, 48.4 percent.
  • The longer a visit went on and the more information presented, the less patients remembered.
  • Older patients did have a harder time than younger ones when consultations were longer and more information was presented.
  • The number of questions that a patient asked during the visit actually reduced the amount that they recalled.
  • Patients with a poorer prognosis remembered less, despite age.
  • The number of specific details about prognosis also made it harder to remember information from the visit, despite whether prognosis was favorable or not.

Jesse Jansen and colleagues wrote,

Recall is not simply a function of patient age. Age only predicts recall when controlling for amount of information presented. Both prognosis and information about prognosis are better predictors of recall than age. These results provide important insights into intervention strategies to improve information recall in patients with cancer.

SOURCE: Jansen et al. Journal of Clinical Oncology, Published ahead of print, October 20, 2008.

What This Means for Patients and Families

Patients remember less than half of what they hear during an initial visit to an oncologist.  The longer the visit and the more information presented, the less they are likely to recall.

Age doesn’t matter, so both younger and older patients probably will benefit by having someone go with them to the visit, listen to what the doctor says, and perhaps take notes.

Despite what seems obvious, asking more questions doesn’t help recall.  Making a short list of important questions may help focus the visit and help patients remember critical answers.

Almost all patients did not want either information or details about their diagnosis, treatment, or prognosis withheld.  They wanted to hear it, despite age.

Keeping the initial visit short enough to give patients important information, but not send them into information overload is important for doctors, patients, and families.

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