The impact of physician’s sequence [1st vs 2nd] and posture [sitting vs standing] on cancer patients’ physician preference and perception of compassion
18513 Background: Our group previously found in a cross-over RCT in 69 advanced cancer patients [P] that the sitting posture was preferred; we also found that patients consistently chose the physician [MD] they observed in 2nd order [ASCO 2003:2958]. The effect of sequence on MD preference and perception of compassion had not been reported before. The purpose of this study was to assess if P preferred MD seen in 2nd order after controlling for posture. Methods: Advanced cancer P were randomized to observe 2 9-minute videos of a P/MD interaction. Both videos were identical except for the posture of the MD [sitting versus standing]. After a 2–3 minute assessment P were crossed-over into viewing the opposite video. Investigators were blinded to the type of video observed. P were blinded to the purpose of the study and difference between videos. Results: 168 P [98%] were evaluable. The mean perception of compassion [0 = worst, 50 = best] was 29 ± 13 for the 1st MD versus 33 ± 11 for the 2nd MD [p < 0.001]. P also preferred sitting [33 ± 11] versus standing [29 ± 12, p < 0.001]. The overall impression [0 = worst, 10 = best] for the MD seen 2nd versus 1st was 6.5 ± 2.3 versus 5.7 ± 2.7 [p ≤ 0.001]. All differences in response were independent on posture. 119/168 P [71%] perceived a difference between the 2 MDs and this difference was considered ≥ moderately important in 95 P [80%]. 76/168 P preferred the 2nd MD [45%, 95% CI, 38–53], 38/168 P preferred the 1st MD [23%, 95% CI, 16–29], and 54/168 P had no preference [32%, 95% CI, 25–39]. 49/114 P who expressed a preference perceived their preferred MD had spent more time with the P [43%]. 87/168 P preferred their MD to sit [52%] but they considered posture more important than time in 23 cases [20%], friendliness in 18 [15%], patience in 16 [14%], caring in 15 [14%], and respect in 18 [16%]. Conclusions: P prefer MDs they see in 2nd order, they have an overall better impression of them and consider them more compassionate, and they perceive that they spent more time with their P, independently on the MD’s chosen posture. Most P also prefer MDs to sit but posture is rated as a relatively low priority in P/MD communication. These findings are important for clinical care and trial participation. No significant financial relationships to disclose.