Abstract 42: Patient-Provider Communication in the Setting of Advanced Cancer: Experience and Views from Rwanda

Purpose: Caring for patients with advanced cancer involves complex patient-provider communication (PPC), including disclosure of diagnosis, discussion of prognosis, decision-making about treatment, delivery of bad news, and transitions in goals of care. Values and norms that influence PPC differ across diverse cultural and socioeconomic contexts. We aimed to characterize PPC experiences and preferences among patients and providers at Butaro Hospital in Rwanda, understand facilitators and barriers to high quality PPC, and collect suggestions for improvement. Methods: We conducted semi-structured interviews with a purposive sample of 11 oncology providers and 11 adult patients with advanced cancer. Interviews were recorded, transcribed, translated to English, coded using software, and analyzed using framework thematic analysis. Results: Participants reported both strengths and opportunities for improvement in PPC at Butaro. Strengths include routine explanation of diagnosis, treatment plan, and potential side effects, aided by a consent form and a dedicated counselor. Patients reported that PPC focuses on symptoms and treatment plan discussion, but is limited in truth telling about prognosis, especially when goals of care transition from curative to palliative. Facilitators to quality PPC include multidisciplinary team commitment, patient trust toward providers, provider communication style, and strong resilience in distressing clinical situations. While patients perceived power imbalance between patients and providers as the main barrier to PPC, providers cited inadequate time due to work overload, discomfort facing sad situations, and unfavorable physical environment as main barriers. Suggestions to improve PPC include training providers in communication skills, patient and family education and empowerment, more time and private spaces, and standardizing approaches to harmonize PPC. Conclusion: PPC at Butaro works well though there is room for improvement. Understanding how cultural norms and values regarding poor prognoses influence patient and provider communication preferences can inform strategies to improve PPC and ensure patient-centered care in Rwanda and similar settings. Citation Format: Pacifique Uwamahoro, Hubert Tuyishime, Vincent Cubaka, Egide Mpanumusingo, Anita Ho, Katherine Van Loon, Rebecca J. DeBoer. Patient-Provider Communication in the Setting of Advanced Cancer: Experience and Views from Rwanda [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 42.