How to Prepare for a Short Oncology Appointment

An oncology follow-up is usually booked for fifteen to twenty minutes, and much of that goes to the examination, the computer, blood results, and scheduling. The open conversation in the middle is often five to eight minutes. Preparation is not about being organized for its own sake. It is about deciding in advance what those minutes get spent on.

Write your questions down, rank them, and keep the top three on a single page. Long lists get cut off by the clock at exactly the point where your most important question sits, because most people save the frightening one for last. Put the frightening one first.

Hand a copy to the doctor at the start: "I have three things I need to get through today - can we start with these?" This changes the structure of the visit more than anything else you can do, and it lets the doctor pace the appointment around your agenda instead of discovering it at the door.

The Ask Me 3 framework covers the minimum for any visit: What is my main problem? What do I need to do? Why is it important for me to do this?

Message your questions through the patient portal 48 hours before the appointment. Nurses and navigators often answer the logistical ones in writing before you arrive, which frees the visit for questions only the doctor can answer. It also gives the doctor time to look something up.

• A current medication list with doses, plus over-the-counter drugs, supplements, and herbal products, several of which interact with cancer treatment.
• A symptom log: date it started, how often, severity out of ten, what makes it better or worse, and what you can no longer do because of it. Dates and lost function beat adjectives.
• A list of other doctors involved and any tests done elsewhere.
• Your insurance card, pharmacy name, and the date of your last scan.
• A pen and paper, or a second person whose job is writing.

The first sixty seconds set the visit. Try: "Before we start, the three things I need today are the scan result, this new pain in my hip since the last cycle, and whether I can travel in October." Raising a new symptom in the first minute is far more likely to get it investigated than mentioning it as the doctor stands to leave.

Two people retain more than one. Assign the roles explicitly: you listen and ask, they write down numbers, drug names, and dates. Agree beforehand that they may ask for spellings and interrupt to say "Can you explain that word?" Give them the question list too, so anything you forget still gets asked.

Before you leave, say back what you understood: "So the plan is two more cycles, a CT after the second, and I call if my temperature goes above 100.4 - right?" Misunderstandings surface here, while the person who can correct them is still in the room. Then ask two closing questions:

• "What should make me call you before the next visit, and what number do I use after hours?"
• "What would make you change this plan?"

Ask for the after-visit summary and check that the plan you just repeated matches what is written in it. In the US your clinician's note and your results normally post to the portal quickly, so you can read them the same day and send a message if something does not match.

Some conversations do not fit a follow-up slot: whether to start treatment, whether to stop, surgery versus radiation, joining a trial. Ask for a longer appointment specifically for the decision - "Can we book a longer visit to go through the options?" - and ask whether a nurse navigator or oncology social worker can join. Squeezing a major decision into a routine slot is how people end up consenting to something they have not yet understood.

• IHI - Ask Me 3: Good Questions for Your Good Health
• AHRQ - Use the Teach-Back Method
• NCI - Questions to Ask About Your Diagnosis
• NCI - Managing Cancer Care
• ONC / HealthIT.gov - Information Blocking