Patient Coaching and End-of-Life Discussions in Advanced Cancer

Key Points

  • Intervention group patients were more likely to ask questions regarding prognosis compared with control patients.
  • Prognosis was discussed by < 20% of intervention group patients.

As reported by Rodenbach et al in the Journal of Clinical Oncology, a patient coaching session for patients with advanced cancer prior to an oncologist visit made it more likely that patients would discuss their prognosis during the visit. However, prognosis was still infrequently discussed.

Study Details

The data for the current post hoc analysis were from the patient-intervention component of a National Cancer Institute–sponsored trial testing interventions aimed at improving communication among oncologists, patients with advanced cancer, and their caregivers. The study involved patients with advanced nonhematologic cancer from practices of 24 oncologists in western New York. Twelve intervention-group oncologists received individualized communication training and 84 of their patients received a previsit individualized communication coaching session led by social workers; it incorporated a question prompt list with topics related to current and future cancer care and end-of-life issues. Control group oncologists (n = 12) and their patients (n = 86) received no intervention. Topics of interest brought up by intervention group patients during the coaching session were recorded for comparison with topics discussed during the subsequent visit.

Effect of Patient Intervention

Question prompt list–related topics were brought up by 70.2% of intervention group patients at their next oncologist office visit, compared with 32.6% of control patients (P < .001). The topic of prognosis was brought up by 16.7% vs 5.8% of patients (P =.03). Of 262 topics of interest identified by intervention group patients during their coaching session, 158 topics (60.3%) were question prompt list–related and 20 topics (12.7%) were about prognosis. Intervention group patients brought up 82.4% of the identified topics of interest during the office visit.

The investigators concluded: “A combined coaching and [question prompt list] 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.”

The study was supported by National Cancer Institute grants.

Rachel A. Rodenbach, MD, of the University of Pittsburgh Medical Center Montefiore Hospital, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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