Promoting End-of-Life Discussions in Advanced Cancer: Effects of Patient Coaching and Question Prompt Lists
Autor: | Peter Sullivan, Sandy Plumb, Beth Hoh, Phyllis Butow, Rachel Rodenbach, Kevin Fiscella, Richard L. Kravitz, Adam Walczak, Paul R. Duberstein, Ronald M. Epstein, Guibo Xing, Kim Brandes |
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Rok vydání: | 2017 |
Předmět: |
Adult
Male Advance care planning Cancer Research medicine.medical_specialty Attitude to Death Psychological intervention Alternative medicine MEDLINE Coaching law.invention Advance Care Planning 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Neoplasms Intervention (counseling) Post-hoc analysis medicine Humans 030212 general & internal medicine Aged Oncologists Physician-Patient Relations Terminal Care business.industry Communication ORIGINAL REPORTS Middle Aged Oncology 030220 oncology & carcinogenesis Physical therapy Female business |
Zdroj: | Journal of Clinical Oncology. 35:842-851 |
ISSN: | 1527-7755 0732-183X |
Popis: | Purpose To build on results of a cluster randomized controlled trial (RCT) of a combined patient-oncologist intervention to improve communication in advanced cancer, we conducted a post hoc analysis of the patient intervention component, a previsit patient coaching session that used a question prompt list (QPL). We hypothesized that intervention-group participants would bring up more QPL-related topics, particularly prognosis-related topics, during the subsequent oncologist visit. Patients and Methods This cluster RCT with 170 patients who had advanced nonhematologic cancer (and their caregivers) recruited from practices of 24 participating oncologists in western New York. Intervention-group oncologists (n = 12) received individualized communication training; up to 10 of their patients (n = 84) received a previsit individualized communication coaching session that incorporated a QPL. Control-group oncologists (n = 12) and patients (n = 86) received no interventions. Topics of interest identified by patients during the coaching session were summarized from coaching notes; one office visit after the coaching session was audio recorded, transcribed, and analyzed by using linear regression modeling for group differences. Results Compared with controls, more than twice as many intervention-group participants brought up QPL-related topics during their office visits (70.2% v 32.6%; P < .001). Patients in the intervention group were nearly three times more likely to ask about prognosis (16.7% v 5.8%; P =.03). Of 262 topics of interest identified during coaching, 158 (60.3%) were QPL related; 20 (12.7%) addressed prognosis. Overall, patients in the intervention group brought up 82.4% of topics of interest during the office visit. Conclusion A combined coaching and QPL intervention was effective to help patients with advanced cancer and their caregivers identify and bring up topics of concern, including prognosis, during their subsequent oncologist visits. Considering that most patients are misinformed about prognosis, more intensive steps are needed to better promote such discussions. |
Databáze: | OpenAIRE |
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