Patient and clinician experience of a serious illness conversation guide in oncology: A descriptive analysis

Autor: Luca A. Koritsanszky, Joanna Paladino, Lauren Nisotel, Evan M. Benjamin, Erik K. Fromme, Bridget A. Neville, Justin J. Sanders, Rachelle Bernacki, Kate Miller, Susan D. Block
Rok vydání: 2020
Předmět:
Male
0301 basic medicine
Oncology
Advance care planning
Cancer Research
medicine.medical_specialty
Palliative care
media_common.quotation_subject
serious illness communication
lcsh:RC254-282
03 medical and health sciences
0302 clinical medicine
Neoplasms
Surveys and Questionnaires
Intervention (counseling)
Internal medicine
Patient experience
medicine
Humans
advanced cancer
Radiology
Nuclear Medicine and imaging
Conversation
advance care planning
Hopefulness
Qualitative Research
Original Research
media_common
Oncologists
Physician-Patient Relations
palliative care
patient experience
business.industry
Communication
clinician experience
Clinical Cancer Research
Middle Aged
lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Clinical trial
030104 developmental biology
030220 oncology & carcinogenesis
Feasibility Studies
prognostic communication
Anxiety
Female
Family Relations
medicine.symptom
business
goals of care communication
Zdroj: Cancer Medicine, Vol 9, Iss 13, Pp 4550-4560 (2020)
Cancer Medicine
ISSN: 2045-7634
DOI: 10.1002/cam4.3102
Popis: Background/objective Oncology guidelines recommend earlier communication with patients about prognosis and goals‐of‐care in serious illness. However, current evidence leaves gaps in our understanding of the experience of these conversations. This analysis evaluates the patient and clinician experience of a conversation using a Serious Illness Conversation Guide (SICG). Design/setting Secondary analysis from a cluster‐randomized clinical trial in a northeastern cancer center. Participants Physicians, advanced practice clinicians, and patients with advanced cancer who received the intervention. Intervention SICG, clinician training, systems‐changes. Main outcomes and measures The patient questionnaire assessed perceptions of the conversation and impact on anxiety, hopefulness, peacefulness, sense of control over medical decisions, closeness with their clinician, and behaviors. The clinician questionnaire assessed feasibility, acceptability, and impact on satisfaction in their role. Results We enrolled 54 clinicians and 163 patients; 41 clinicians and 118 patients had a SICG discussion. Most patients described the conversation as worthwhile (79%) and reported no change or improvement in their sense of peacefulness, hopefulness, and anxiety (on average 79%); 56% reported feeling closer with their clinician. Qualitative patient data described positive behavior changes, including enhanced planning for future care and increased focus on personal priorities. Nearly 90% of clinicians agreed that the SICG facilitated timely, effective conversations, and 70% reported increased satisfaction in their role. Conclusion Conversations using a SICG were feasible, acceptable, and were associated with positive experiences for both patients and clinicians in oncology in ways that align with national recommendations for serious illness communication. This trial is registered at ClinicalTrials.gov: NCT01786811 https://clinicaltrials.gov/ct2/show/NCT01786811.
This descriptive analysis reports the patient and clinician experience of a structured conversation about patients' values, goals, prognosis, and care preferences in the outpatient setting in oncology. Conversations using the Serious Illness Conversation Guide were feasible, acceptable, and were associated with positive experiences for both patients with advanced cancer and oncology clinicians in ways that align with national recommendations for serious illness communication.
Databáze: OpenAIRE
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