Supporting doctor-patient communication: Providing a question prompt list and audio recording of the consultation as communication aids to outpatients in a cancer clinic

Objective

To document the effect of a cancer specific question prompt list (QPL) on patients question asking and shared decision-making (SDM), and to evaluate the combined effect of the QPL and consultation audio recording (CAR) on patient outcomes.

Ready for SDM- evaluation of an interprofessional training module in shared decision making – A cluster randomized trial

ObjectiveReady for SDM was developed in Norway as a comprehensive modularized curriculum for health care providers (HCP). The current study evaluated the efficacy of one of the modules, a 2-hour interprofessional SDM training designed to enhance SDM competencies.MethodsA cluster randomized controlled trial was conducted with eight District Psychiatric Centres randomized to wait-list control (CG) or intervention group (IG). Participants and trainers were not blinded to their allocation. The IG received a 2-hour didactic and interactive training, using video examples. The primary outcome was the agreement between the participants’ and an expert assessment of patient involvement in a video recorded consultation. The SDM-knowledge score was a secondary outcome.ResultsCompared to the CG (n = 65), the IG (n = 69) judged involvement behavior in a communication example more accurately (mean difference of weighted T, adjusted for age and gender:=?0.098, p = 0.028) and demonstrated better knowledge (mean difference=?0.58; p = 0.014). A sensitivity analysis entering a random effect for cluster turned out not significant.ConclusionThe interprofessional group training can improve HCPs’ SDM-competencies.Practice implicationsAddressing interprofessional teams using SDM communication training could supplement existing SDM training approaches. More research is needed to evaluate the training module’s effects as a component of large-scale implementation of SDM.     

Effectiveness of a web-based, individually tailored decision aid for depression or acute low back pain: a randomized controlled trial

Objective

To evaluate the effectiveness of a web-based, individually tailored decision aid (Patient Dialogue) on depression or acute low back pain for insurees of a German sickness fund.

Methods

Patient Dialogue (PD) was compared to the non-tailored Static Patient Information (SPI) in an online randomized controlled trial (RCT). The primary outcome was decisional conflict; secondary outcomes included knowledge, preparation for decision-making, preference for participation, involvement in decision-making, decision regret, and adherence.

Results

Out of 2480 randomized participants, 657 (26.5%) provided analyzable data immediately after using the system. Three months later, data from 131 (5.3%) participants could be included in the analysis. The PD group reported a significantly lower overall decisional conflict than the SPI group (38.7 vs. 45.1; p = 0.028 via multiple imputation estimator). The largest standardized effect (Cohen's d 0.56) resulted from the preparation for decision-making (PD 59.4 vs. SPI 46.8; p < 0.001).

Conclusion

PD may be an effective tool to reduce decisional conflict and prepare participants for treatment decision-making. However, the large dropout rate needs to be taken into account.

Practice implications

This study shows how a health insurance fund can support shared decision-making and how a decision aid can be evaluated in a RCT under routine care conditions.     

Extending decision support: preparation and implementation

The shift towards patient-centered care requires innovative, flexible decision-making models. Current decision aids provide information and help patients clarify values. By focusing almost exclusively on these two components, the aids miss some necessary elements that can improve decision quality. We discuss two such elements in this paper. First is avoiding the tendency to move into providing information about options and outcomes before adequate preparation. The second is the tendency to neglect to provide adequate implementation support.     

Decision preparation, satisfaction and regret in a multi-center sample of men with newly diagnosed localized prostate cancer

Objective

To describe relationships between use of the Personal Patient Profile-Prostate (P3P) decision support system and patient characteristics, and perceived preparation for decision making (PrepDM), satisfaction and decisional regret in the context of prostate cancer treatment choice.

Methods

494 men with localized prostate cancer (LPC) were randomized to receive the P3P intervention or usual care and completed pre-treatment, 1-month and 6-month outcome measures. Multivariable linear regression models were fit for each outcome.

Results

Physician consult visits prior to enrollment, race/ethnicity, and use of clinic-provided books were significant predictors of perceived PrepDM at 1 month. Prior Internet use and PrepDM significantly predicted 6-month decision satisfaction. Decisional regret was significantly predicted by demographics, anxiety, PrepDM score, and EPIC bowel domain score at 6 months. Use of P3P did not predict any outcome.

Conclusion

While the P3P intervention did not significantly affect the outcomes, pre-enrollment information and preparation were strong predictors of the 1- and 6-month outcomes. Decision regret was significantly influenced by personal characteristics and post-treatment symptoms/side effects.

Practice implications

Information received and used between biopsy and the treatment options consult visit is likely to make a difference in decision satisfaction.     

Belief in numbers: When and why women disbelieve tailored breast cancer risk statistics

Objective

To examine when and why women disbelieve tailored information about their risk of developing breast cancer.

Methods

690 women participated in an online program to learn about medications that can reduce the risk of breast cancer. The program presented tailored information about each woman's personal breast cancer risk. Half of women were told how their risk numbers were calculated, whereas the rest were not. Later, they were asked whether they believed that the program was personalized, and whether they believed their risk numbers. If a woman did not believe her risk numbers, she was asked to explain why.

Results

Beliefs that the program was personalized were enhanced by explaining the risk calculation methods in more detail. Nonetheless, nearly 20% of women did not believe their personalized risk numbers. The most common reason for rejecting the risk estimate was a belief that it did not fully account for personal and family history.

Conclusions

The benefits of tailored risk statistics may be attenuated by a tendency for people to be skeptical that these risk estimates apply to them personally.

Practice implications

Decision aids may provide risk information that is not accepted by patients, but addressing the patients’ personal circumstances may lead to greater acceptance.     

Effect of question prompt lists for cancer patients on communication and mental health outcomes—A systematic review

ObjectiveTo provide a systematic review on the effects of question prompt lists (QPL) in oncological settings.MethodsA systematic literature search was conducted in Medline, PsycINFO and the Cochrane Collaboration. Randomized controlled studies (RCTs) that evaluated QPL-only interventions were included. Risk of bias of included studies was evaluated using the Cochrane RoB 2 tool. Data concerning effects on communicative processes in patient-physician relationship and psychological outcomes were analyzed.Results10 RCTs met the inclusion criteria. Results suggest that QPLs lead to a shift of topics discussed. There were weak indications that QPL interventions increase anxiety shortly before and after consultations, but may decline anxiety during follow-up. Patients consistently perceive QPLs as more helpful than usual information sheets. QPL-only interventions show limited impact on communicative processes and psychological outcomes. They help not to forget or discuss important questions.ConclusionWith a better integration in patient-physician communication QPLs may become a useful tool for patients and physicians. Future research is needed to investigate if there is greater benefit from QPL interventions in specific settings.Practice implicationsQPLs are an inexpensive tool to influence communicative processes positively in oncological consultations.     

Improving youth question-asking and provider education during pediatric asthma visits

Objective

We conducted a pragmatic randomized controlled trial to test the effectiveness of an asthma question prompt list with video intervention to increase youth question-asking and provider education during visits.

The effect of niacinamide on osteoarthritis: A pilot study

Objective To evaluate the effect of niacinamide, on selected parameters of osteoarthritis using a doubleblind, placebo controlled study design.Methods Seventy two patients with osteoarthritis were randomized for treatment with niacinamide or an identical placebo for 12 weeks. Outcome measures included global arthritis impact and pain, joint range of motion and flexibility, erythrocyte sedimentation rate, complete blood count, liver function tests, cholesterol, uric acid, and fasting blood sugar. Compliance was monitored with a pill record sheet and interview.Results Global arthritis impact improved by 29% (95% confidence interval [CI] 6, 46) in subjects on niacinamide and worsened by 10% in placebo subjects (p=0.04). Pain levels did not change but those on niacinamide reduced their anti-inflammatory medications by 13% (95% CI 9, 94; p=0.01). Niacinamide reduced erythrocyte sedimentation rate by 22% (95% CI 6, 51; p<0.005) and increased joint mobility by 4.5 degrees over controls (8 degrees vs. 3.5 degrees; p=0.04). Side effects were mild but higher in the niacinamide group (40% vs 27%, p=0.003).Conclusion This study indicates that niacinamide may have a role in the treatment of osteoarthritis. Niacinamide improved the global impact of osteoarthritis, improved joint flexibility, reduced inflammation, and allowed for reduction in standard anti-inflammatory medications when compared to placebo. More extensive evaluation of niacinamide in arthritis is warranted.accepted by R. O. Day     

Comprehension of confidence intervals in audio-visual patient information materials for people with multiple sclerosis (COCO-MS): A web-based randomised controlled,parallel group trial

ObjectivesTo evaluate patient information materials on confidence intervals (CIs) in multiple sclerosis to be used with patient decision aids.MethodsWeb-based randomised controlled parallel group trial with four study arms. Participants were equally allocated to one of three versions of audio-visual patient information or to a standard written information (arm IV). In the short version (arm III), CIs were explained without using an example, in the other two versions examples were used (arm I and arm II). The examples are based on an apple farmer who wants to estimate the average weight of his apples (arm I) and to test a treatment against worms (arm II). Primary endpoint was comprehension of CIs, assessed with a six-item multiple-choice questionnaire.Results855 of 1068 (80 %) randomised participants completed the survey (71 % arm I, 73 % arm II, 87 % arm III, 90 % arm IV). The median of correctly answered questions on CIs was 4 out of 6 questions in arms I and II and 5 out of 6 questions in arm III. Compared to the standard information (arm IV), all the other arms scored better on the comprehension questionnaire (ANOVA, p ≤ 0.003).ConclusionsInformation about CIs can be presented comprehensibly. High scores and a high rate of completers indicate that the short version is the favourable one.Practice implicationsInformation materials on CIs should be used alongside absolute risk reductions in patient decision aids to enhance the interpretation of study results.     

心理社会干预对乳腺癌患者生存质量影响的对照研究

目的 采用前瞻性随机对照研究,以乳腺癌术后化疗患者为研究对象,探讨心理社会干预对其生存质量的影响.方法 120例病人被随机分配到干预组(60例)和对照组(60例),干预组除常规药物治疗外,接受系统的心理社会干预,如健康教育、放松训练及集体心理干预,对照组只有药物治疗.采用中国癌症化疗患者生活质量量表(QLQ-CCC)及症状自评量表(SCL-90)作为乳腺癌化疗患者生存质量和心理状况的测查指标.结果 乳腺癌化疗患者的生存质量状况以化疗中最差,而治疗结束后,干预组患者的SCL-90总分(131.9士13.7)与对照组(192.5士15.4)相比,P＜0.01;而躯体、心理、社会、总体方面评分分别为:26.7士2.6 分、13.7士1.5 分、8.5士0.8 分、46.9士3.5 分,P＜0.05或0.01,表明干预组患者的不良情绪明显改善,生存质量明显提高.结合对乳腺癌术后化疗患者实施系统的心理社会干预,是改善不良情绪,提高生存质量的有效方法之一,值得推广应用.