Question Prompt Lists and End-of-life Care Discussions

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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 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).

RELATED: Concurrent Hospice Care With Chemotherapy, Radiation Therapy Increasing Among Veterans

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.”

Reference

  1. 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]
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