Executive Summary
Cancer causes stress among the patients and their families, and they need to be motivated to feel confident regarding the care received from the medical professionals. The patient needs to seek a second opinion from any oncology professionals. The second opinion is not always initiated from the patient’s end, and their physician recommends other specialists as part of the second opinion to provide a better treatment approach while also considering cost-efficiency. Choosing second opinions facilitates the treatment options for decision-making among the patients who are motivated in conditions when the patients are very uncertain regarding their options or lack confidence in the treatment decision process. The increasing complexities of treatment decision-making have made the second opinion options very important, allowing the patients to gain confidence in their physician’s decision regarding their proposed management plan. There are several advantages and drawbacks of seeking a second opinion in cancer treatment. The second opinion for cancer patients has been effective in improving patients’ lives. There is a need to integrate a second opinion to make patients aware of the option of seeking a second opinion in case of any significant discrepancies. When patients delay or avoid deciding on a treatment course, second opinions help reassure and expedite the treatment. Hence, this makes the patients emotionally strong while motivating them to deal with any situation during their cancer journey.
Introduction
The expectation of achieving several opinions regarding any clinical case is considered reasonable. Unavoidable variance in taking clinical decisions makes the second opinions (SOs) significant in medical science (Briggs et al., 2008; Zan et al., 2010). It provides cost-effective options for ordinary people by providing relief from unnecessary, expensive and invasive diagnostic and surgical procedures (Rosenberg et al., 1995; Ruchlin et al., 1982). People facing critical surgery decisions or other medical conditions are more likely to opt for a second opinion (SO).
There are different types of second opinions. The first type of SO evolves the patient’s desire to confirm the best diagnosis, treatment, or prognosis suggested by their first physician (Tam et al., 2005). The second type involves the recommendation of the physicians who are looking for advice from a second specialist. The third type of SO is imposed on patients and doctors by the third party insurers in the form of cost containment measures evolved from a prior authorization. Variations have been observed in different countries regarding the health policy, access and payment mechanisms for second opinions. Hence, the second opinion is the reevaluation of the diagnosis and treatment provided by the doctors, processed by a second, independent doctor from the same medical field. The patients opt for a second opinion for various reasons (Moumjid et al., 2007). Mostly, second opinions are requested when the original doctor finds no explanation for the patients’ complaints or when treatment is ineffective.
Research on second opinions has revealed that patients are generally satisfied with the process, even if it has not led to a new diagnosis or treatment. Second opinions have become available for other medical indications besides the surgical procedure, and patients can seek different independent opinions independently. The medical symptoms such as cancer or operations, opt for consulting another expert who helps in clarifying the diagnosis and required therapy. Choosing appropriate treatment proves to be difficult for the patients. Hence, it is necessary to support the patients to allow more involvement in taking the right decisions (Birkmeyer et al., 2013). The second opinion helps inform the patients regarding their medical indication to determine the need and consequences of therapy for considering treatment as an appropriate approach for them.
Second Opinion in Cancer Care
Cancer is known for deteriorating the patients’ quality of life, making them distressed throughout their cancer journey after diagnosis. Hence, there is a need to make them confident regarding their care received from the medical professionals. The patients require a second opinion from the oncology professional other than their own. The second opinion initiated by the patients has been demanding. It has become one of the common approaches in the healthcare system, and surprisingly, the field of oncology possesses a higher rate of second opinions. Patients with cancer undergo diagnosis, prognosis, and treatment plans considered a matter of life and death. As the medical information in oncology is quite complex and often characterised by uncertainties, it increases the patient’s need for a second opinion. In some conditions, the frequency of requesting an SO in oncology remains unclear (Tattersall, 2011).
Advancements in the evaluation and treatment of cancer have evolved clinical decisions with much more complexities. Options for treatment approaches involving surgery, drug therapy, radiation and reconstruction have increased while possessing preventive options for women at high genetic risk for second cancers. It is valid for the decisions regarding the systemic therapies as more of the patients now must consider choices concerning three different medication categories involving endocrine, chemotherapy and biologic in cancer. Some examples include the decision regarding the intake of drug inhibitors for how much duration, undergoing chemotherapy with or without a specific drug before or after surgery and administration of a new biologic agent such as pertuzumab. Also, the diagnostic algorithms responsible for guiding treatment recommendations have become increasingly technical as genomic analysis involving germline genetic testing is integrated into routine care. These decisions of diagnosis and treatment in oncology are considered quite complex and confuse the patients seeking the understanding of a new diagnosis and choosing a comprehensive care plan. Most of the patients have communicated with only recently specialised physicians in charge of their cancer care. The patient should intend between treatment options while appraising the quality of one or more therapeutic relationships. It further increases the burden on the patients with limited educational, social or financial resources.
Therefore, choosing second opinions facilitates the treatment options for decision-making among the patients who are motivated in conditions when the patients are very uncertain regarding their options or lack confidence in the treatment decision process. The increasing complexities of treatment decision-making have made the second opinion options very important, allowing the patients to gain confidence in their physician’s decision regarding their proposed management plan. Also, there is a possibility that second opinions represent poor communication or care coordination in case there are no socioeconomic gradients, evidence of disagreement regarding communication or decision-making, or differential use of indicated treatments in patients who proceed in comparison with those who do not seek any second opinions.
Patients are referred to some medical oncologist after the diagnosis in such situations. Second opinions are opted by the patients and physicians in community practice to implicate appropriate quality of care to the patients. Characterising the patient and oncologists encountering each other’s opinions have evolved the patient to seek a second opinion. Hence, understanding the perspectives of integrating appropriate decision-making regarding the treatment improves cancer care delivery and related outcomes.
Benefits of Second Opinion in Cancer Care
The second opinion has various advantages and disadvantages for patients, physicians, and society. Choosing a second opinion helps the patients medically, resulting in improved diagnosis or treatment. It also makes them mentally strong by enabling them to act more independently and exercise some control and freedom of choice (Axon et al., 2008). Reassurance is achieved for both patients and their physicians while opting for second opinions.
Second opinions in oncology have achieved various benefits resulting in better treatment options. Awareness regarding selecting a second opinion appeals to the patients to double-check their own oncologist’s opinion, gather more information and exhaust all other options. Second opinions have helped the patients by providing them with more confidence and choosing the right treatment plan. A second opinion could point to another type or stage of cancer that might alter the treatment plan. If the initial diagnosis is confirmed, a second opinion will provide additional treatment options to consider.
Some hospitals possess technological aspects that are not included in all the facilities. The healthcare system provides second opinion options recommended by the doctors while utilising state-of-the-art techniques and technology, providing more treatment options for cancer involving advanced or personalised treatments for specific requirements of the patients.
The patients are not obligated to undergo treatment under the initial oncologist. A second opinion is influential in confirming the type and stage of cancer if the patient has a rare cancer diagnosis. In some cases, the patient loses hope as cancer becomes untreatable, as per the doctor’s opinion. But opinion from the second doctor provides potential treatment options to the patients that increase their confidence level for having a second opinion. The second opinion has been effective in saving costs by preventing unnecessary treatment. The patients who opted for second opinions have shown efficacy in reducing the unnecessary, expensive and invasive diagnostic and surgical procedures and saving the rehabilitation costs. The patients have adhered to recommendations of a second opinion for undergoing non-invasive therapy instead of surgical procedure, thus reducing the chances of undergoing surgery and saving the cost.
Drawbacks of Second Opinion in Cancer Care
The possible outcomes of second opinions have revealed that significant decisions of second opinions do not provide medical benefits for patients and, in some cases, might delay their treatment. Second opinions result as physically and psychologically demanding for patients, resulting in disappointment and increased uncertainties and may also affect the relationship with their initial physician (Moumjid et al., 2007). The workload of the physicians is increased and is considered an outcome of the patient’s lack of trust. Considering the feedback as per the societal association, a second opinion may be costly while involving additional consultations and diagnostic testing.
In some of the cases, second opinions evolved from the anxiety of the patients, which is found common in the conditions of cancer diagnosis and treatment. It results in consultation with many physicians for the same illness episode leading to patient confusion and resource waste when there is no informed reconciliation of conflicting opinions and developing a higher risk of in-hospital complications (Chang et al., 2013). Although second opinions are in practice, many of the organised programs have not considered it part, and hence, there is no organised mechanism for the same. Hence, second opinions can be a financial burden for both patients and systems without a regulated agent.
Evidence for Second Opinion being beneficial for patients
Research studies have been conducted to evaluate the impact of opting for second opinion options on patients’ quality of life. The studies have found that 1 out of 6 patients consulted with a doctor have undertaken a second opinion in the past years. Most of the patients choosing a second opinion are the cancer survivors (Hewitt et al., 1999). The weightage of second opinions in radiology and pathology in cancer care is well studied. The experience and expertise of the pathologists involved and the type of specimen and cancer reviewed have affected the discrepancy rate, with higher error rates, mainly evaluated in lymphomas, sarcomas, and cancers of the brain, skin, and female reproductive tract (Renshaw & Gould, 2007).
Follow-up care has been undertaken while choosing a second opinion, and the restaurant outcome on patients’ health has been evaluated. The results have revealed that follow-up biopsies opted for a second opinion diagnosis in cases of discrepancies. The patients have undergone new diagnosis resulting in more consistent with the original diagnosis (Swapp et al., 2013). Also, second reviews of mammography studies have suggested that the first review misses 10% to 20% of malignant tumours. Hence, second opinions positively impact diagnosing the cancer cases and thus improve the patients’ quality of life by providing them with a practical treatment approach at the appropriate time. The second opinion is given to the patient while analysing the extent of its practice that improves the quality of patient care and analyses its variations for different medical conditions. Most patients have been satisfied with the outcome after choosing a second opinion to improve their quality of life. The increasing errors in the diagnostic approach and the option of a second opinion have been appealing and considered a practical strategy among the patients who use them after being recommended by the physicians and doctors. The second opinion significantly changed the diagnosis, prognosis, or treatment and analysed the patients’ satisfaction with the second opinion process.
Impact of a Second Opinion on patient’s diagnosis
Second opinions have attracted several patients in improving their quality of life in situations when they have lost hope. It shows efficacy in reducing the diagnostic errors in medicine in most cases. The second opinion has been considered equal or better quality than the first. The physicians have shown a positive attitude towards patients who are options for a second opinion. Patients have been provided with a better opportunity to communicate with the specialist to enhance the quality of care and reduce the inappropriate diagnosis or treatment. Second opinions provide better access to newer techniques or facilities and consulting physicians with more experience with complex or rare cases. The second opinion services determine cancer treatment in high-volume centres that provide more effective treatment than the previous ones.
The second opinion for cancer patients has also been effective in improving the lives of patients living in rural areas and overseas. Several insurers offer the cost and expenditure by seeking second opinions for their treatment. Some medical specialities experienced significantly more changes in diagnosis or treatment, and changes in diagnosis and treatment had a more significant impact in patients with cancer than in patients with general medical concerns. There is a need to integrate a second opinion to make patients aware of the option of seeking a second opinion in case of any significant discrepancies. When patients delay or avoid deciding on a treatment course, second opinions help reassure and expedite the treatment. Hence, this makes the patients emotionally strong while motivating them to deal with any situation during their cancer journey.
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