Reuters Health Information: Coaching helps give a voice to advanced cancer patients
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
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
But there remains considerable room for improvement, they
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.
J Clin Oncol 2017.