Reducing uncertainty: motivations and consequences of seeking a second opinion in oncology

Figures & data

Figure 1. Flow chart of participant inclusion and overview of the SO-COM study procedures (incl. survey measures used in the presented analyses). Note: *N = 77 includes every respondent who provided self-report and/or had their SO audio-recorded, of which N = 72 had provided self-report data and complete data was available from N = 70 patients at T₀.

Table 1. Background characteristics of all patients (N = 70).

	Mean (SD); Median; range
Age	58.3 (10.5); 58.0; 28–85 years
Time since (primary) diagnosis	46.2 (71.7); 15.5; 1 month–31 years
	n (%)
Sex
Female	44 (62.9%)
Male	26 (37.1%)
Relationship status
Partnered/married	63 (90.0%)
Single	7 (10.0%)
Level of education
Low (lower level vocational training or less)	22 (31.4%)
Middle (medium level vocational training)	20 (28.6%)
High (college, university)	28 (40.0%)
Type of diagnosis
Breast tumors	22 (31.4%)
Gastrointestinal tumors	21 (30.0%)
Urological tumors	10 (14.3%)
Gynecological tumors	6 (8.6%)
Other	11 (15.7%)
Tumor stage
Early stage	9 (12.9%)
Advanced	61 (87.1%)

Table 2. Patient- and oncologist-reported motivations and expectations of seeking a SO^a.

	Patients	Referring oncologists
	(N = 70)^b	(N = 22)^b
Motivations	n (%)	n (%)
I wanted to know what other specialists would advise	46 (65.7%)	9 (40.9%)
I wanted to be sure that I had tried everything	41 (58.6%)	9 (40.9%)
I needed more information	17 (24.3%)	1 (4.5%)
Others advised to seek a SO	17 (24.3%)	3 (13.6%)
I was doubting my diagnosis/ proposed treatment plan	12 (17.1%)	1 (4.5%)
I was confused by contradictory information/ opinions	11 (15.7%)	3 (13.6%)
I was hoping for specialized treatment/ a clinical trial^c	7 (10.0%)	–
I was not on good terms with my referring physician	4 (5.7%)	–
My referring physician recommended to seek a SO^c	4 (5.7%)	5 (22.7%)
I did not have enough trust in my referring physician	3 (4.3%)	–
Expectations^d	n (%)	M (SD)
Different/ better treatment options^e	44 (62.9%)	3.1 (1.0)
Confirmation of the first opinion	29 (41.4%)	3.9 (0.5)
Support in deciding between treatment options	25 (35.7%)	3.3 (1.0)
Receiving more information/ explanations	21 (30.0%)	3.6 (1.1)
Better prognosis^e	10 (14.3%)	2.0 (0.8)
Better medical care	8 (11.4%)	2.3 (0.8)
Better communication with physician	7 (10.0%)	2.6 (0.7)
A more objective opinion	4 (5.7%)	2.2 (0.8)
Different diagnosis^e	2 (2.9%)	1.6 (0.6)

^aBoth lists are based on a systematic literature review [1].

^bPercentages exceed 100% as patients could indicate as many motivations as they wished.

^cRepresents an added category based on patients’ open answers, other free-text answers could be included in the 8 preexisting categories (note that the oncologist questionnaire asked whether they advised their patients to seek a SO).

^dExpectations were assessed among patients using a check list (yes/no, multiple options could be selected) and among referring oncologists using a list with response options on a 5-point Likert scale. Wording of the items for oncologists differed slightly from those of patients. All survey items available from the authors upon request.

^ePatients who reported any/all of these categories were included in ‘expected something different’.

Table 3. Descriptive statistics of patient- and oncologist-reported outcomes, and effects over time.

		T1 (n = 63)	T2 (n = 50)
		N (%)	N (%)
Patient-reported medical outcome:
Completely the same		21 (33.3%)	28 (56.0%)
Largely the same		35 (55.6%)	14 (28.0%)
Largely different		5 (7.9%)	2 (4.0%)
Completely different		2 (3.2%)	5 (10.0%)
Missing		–	1 (2.0%)
Consulting oncologist-reported medical outcome:^a
Completely the same		19 (35.8%)	–
Largely the same		30 (56.6%)	–
Largely different		2 (3.8%)	–
Completely different		2 (3.8%)	–
	T0	T1	T2
	M(SD), range	M(SD), range	M(SD), range	F	p
Uncertainty (n = 50)^b	2.56 (0.86), 1.00–4.00	2.03 (0.82), 1.00–3.83	2.12 (0.79), 1.00–4.00	6.82	.002
Anxiety (n = 50)^b	2.08 (0.50), 1.05–3.40	1.93 (0.44), 1.00–2.65	2.00 (0.57), 1.05–3.40	3.07	.055

^aMissing data at T1: n = 10.

^bDescriptive statistics are presented for n = 50 patients who completed all measurement points and were included in repeated measures analyses.

Figure 2. Estimated marginal means of uncertainty from T₀-T₂ for patients split by self-reported medical outcome (similar vs. different SO); and observed means for the full sample across three time points.

Hillen MA, Medendorp NM, Daams JG, et al. Patient-driven second opinions in oncology: a systematic  review. Oncologist. 2017;22(10):1197–1211.

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