In a study reported in JCO Oncology Practice, Bickell et al found that providing oncologists with communication skills training did not improve the frequency or quality of goals-of-care discussions for patients with advanced cancer.
Study Details
In the study, 22 oncologists were randomly assigned to a communication intervention (intervention group, n = 11) or usual care (control group, n = 11). The intervention consisted of a 2-hour communication skills training session and four coaching sessions intended to enhance physician ability to elicit patient values (ie, what in life is important to the patients given their advanced cancer diagnosis) in order to improve quality of goals-of-care discussions. A total of 255 patients with newly diagnosed advanced cancer with life expectancy of < 2 years being treated by the oncologists (155 by oncologists in the intervention group, 110 by oncologists in the control group) were surveyed at baseline and 6 months after physician training, providing ratings of specific elements of physician discussions. Discussions were audiotaped and evaluated by blinded physicians trained in communication skills.
Key Findings
At baseline, patient values were elicited by 27% of the intervention group vs 9% of the control group (P = .57). After intervention, values were elicited by 55% vs 0% (P = .01).
Post-intervention, the occurrence of a goals-of-care discussion was reported by 48% of intervention group patients vs 51% of control group patients (P = .61).
Use of a composite score for prevalence (based on change in frequency) or quality (based on change in percentage of patients expressing satisfaction) of goals-of -care discussions showed no difference between the intervention vs control groups (global odds ratio = 0.84, 95% confidence interval = 0.57–1.23). Overall, 73% of patients treated by the intervention group vs 77% of patients treated by the control group who had goals-of-care discussions indicated that the discussions helped to clarify their values.
There were no differences between patients of the intervention vs control groups in mean hospitalizations (0.47 vs 0.42, P = .63) or mean number of emergency department visits per patient (0.48 vs 0.31, P = .13) over 6 months and no difference in intensive care unit admissions (5% vs 9%, P = .65) or use of chemotherapy (26% vs 16%, P = .39) within the last 4 weeks of life among 66 patients who died (38 vs 28, P = .85).
The investigators concluded, “Use of a coaching model focused on teaching oncologists to elicit patient values improved that skill but did not increase prevalence or quality of goals-of-care discussions among patients with advanced cancer. There was no impact on high care utilization at end of life.”
Nina A. Bickell, MD, of Icahn School of Medicine at Mount Sinai, is the corresponding author for the JCO Oncology Practice article.
Disclosure: The study was funded by the Patient-Centered Outcomes Research Institute (PCORI). For full disclosures of the study authors, visit ascopubs.org.
