Coaching helps give a voice to advanced cancer patients

Last Updated: 2017-02-01

By Megan Brooks

NEW YORK (Reuters Health) - A two-pronged approach may improve end-of-life discussions among advanced cancer patients and their oncologists, new research suggests.

Advanced cancer patients who were coached on how to talk with their oncologist and given a question prompt list (QPL), and whose oncologists were trained to be receptive to their questions and concerns, were more apt to bring up topics relevant to their disease status and prognosis than a control group who didn't get this training, the researchers found.

"Patients with advanced cancer may have concerns and questions about 'big picture' topics including prognosis and end of life issues throughout the course of their illness. Broaching these topics can be scary for the patient and uncomfortable for the clinician," Dr. Rachel Rodenbach of the University of Pittsburgh Medical Center in Pennsylvania told Reuters Health.

"Providing additional support to the patient can help empower them to ask questions relevant to their care and future decision making. Coaching and materials outlining potentially relevant questions are some ways to do this. However, even more important is oncologists' encouragement of patient involvement - by inviting questions, exploring patients' concerns, and reexamining patients' understanding of their disease and wishes for information continuously throughout the course of their illness," Dr. Rodenbach said by email.

In the VOICE cluster randomized controlled trial, she and her colleagues found that brief communication training for oncologists, coupled with coaching and a QPL for their advanced cancer patients, can improve communication. The combined intervention boosted patient engagement and increased physician responsiveness to patient emotions, leading to more discussions of prognosis and treatment choices, according to the results published earlier this year in JAMA Oncology (http://bit.ly/2kMbjLU).

A post hoc analysis zeroing in on the patient component shows that it was effective in helping patients and their caregivers bring up topics of concern during subsequent oncologist visits.

Compared with controls, more than twice as many intervention-group patients brought up relevant topics included in the QPL during their office visits (70.2% vs. 32.6%; p<0.001), and nearly three times more likely to ask about prognosis (16.7% vs. 5.8%; p=0.03), the researchers report online January 30 in the Journal of Clinical Oncology.

"The finding that most topics of interest were brought up by patients and caregivers (rather than clinicians), coupled with the finding that oncologists nearly always responded to topics raised by patients regardless of whether they received training, suggests that discussion of topics important to patients was more a result of the patient/caregiver-targeted component of the intervention than of oncologist communication training," the authors note.

But there remains considerable room for improvement, they say.

Although these findings represent "an important advance in the promotion of discussions that have an effect on future treatment decisions, prognosis discussions remain infrequent," they note in their paper.

"Patients in the intervention did bring up the topic of prognosis almost three times as often as patients in the control arm, underscoring effectiveness of the intervention. However, the overall frequency was low - fewer than one in five intervention patients," Dr. Rodenbach said.

"Most interesting to me," she added," is the observation that even after receiving skilled coaching on ways to ask about prognosis and topics related to end-of-life decision making, patients frequently chose not to bring up these topics with their oncologists. Given the large body of research highlighting patient's unrealistic treatment expectations and prognosis overestimation, our results suggest that a more intensive or longitudinal approach may be necessary to promote communication about end of life topics."

The study had no commercial funding and the authors have indicated no relevant conflicts of interest.

SOURCE: http://bit.ly/2jR6uTa

J Clin Oncol 2017.