Question Prompt Lists and End-of-life Care Discussions
Participation in a coaching session with a question prompt list increased the number of questions asked by patients during an oncology visit.
Participation in a coaching session with a question prompt list (QPL) increased the number of questions asked by patients during an oncology visit, which helped to improve patient-physician communication, according to a post hoc analysis published in the Journal of Clinical Oncology.1
Many patients fail to engage health care providers about their concerns. QPLs were identified by researchers as a possible method to help patients ask their oncologists more questions about their disease and care. This post hoc analysis evaluated how a previsit coaching intervention with a QPL affected the discussion held during the oncology office visit.
The QPL included questions about the goals of treatment, symptom management, prognosis, lifestyle and support, hospice and end-of-life care, and preferences for care.
In the trial, 170 patients with non-hematologic stage III or IV cancer with a life expectancy of 12 months or less were randomly assigned to receive a previsit communication coaching session with a QPL or no intervention. The trial also included 24 oncologists randomly assigned to receive individualized communication training or no intervention.
In the post hoc analysis, the intervention arm asked a mean 17.4 questions compared with 13.6 questions in the control arm (P = .11). The number of QPL-related questions was significantly higher in the intervention arm compared with the control arm (1.7 vs 0.6, respectively; P < .001).
Patients who received the intervention were more likely to prompt discussion of prognosis (16 vs 5; P = .006), expressions of fear/avoidance (9 vs 0; P = .0025), and symptoms and quality of life (20 vs 4; P = .0025).
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According to the authors, it is critical that patients are fully informed to make appropriate care decisions. This intervention was “effective in giving a voice to patients and their caregivers during office visits with their oncologists.”
- Rodenbach RA, Brandes K, Fiscella K, et al. Promoting end-of-life discussions in advanced cancer: effects of patient coaching and question prompt lists. J Clin Oncol. 2017 Jan 30. doi: 10.1200/JCO.2016.68.5651 [Epub ahead of print]