Testing the utility of a cancer clinical trial specific Question Prompt List (QPL-CT) during oncology consultations

Objective

A Question Prompt List (QPL) is a proven, simple intervention to aid patients to be active participants in consultations with their physicians by asking questions. We aimed to further develop and test the efficacy of a targeted QPL for clinical trials (QPL-CT).

Methods

Breast, Lung and Genitourinary cancer patients who were facing a discussion about a therapeutic clinical trial completed short pre- and post-consultation questionnaires and used the QPL-CT in their discussions with their oncologists.

Results

30 participants were recruited from 6 oncologists. All QPL-CT questions were selected by at least one-third of participants. Participants mostly wanted and asked questions about personal trial benefit. Oncologists provided information about personal benefit to varying degrees, thus patients did not ask some questions. Patients were still left with some unasked and unanswered questions.

Conclusion

The QPL-CT has potential as a simple, inexpensive intervention to aid such communication. Further investigation is needed to demonstrate the efficacy of the QPL-CT in improving cancer patient outcomes.

Practice implications

These preliminary finding suggest that important areas of clinical trials are overlooked in clinical consultations. The QPL-CT may be an effective method to encourage oncologists to endorse patient question asking about clinical trials and prompt patient questions.     

Identifying patient information needs about cancer clinical trials using a Question Prompt List

Objective

Question Prompt Lists (QPLs) have demonstrated significant promise in facilitating communication in general, surgical and palliative oncology settings yet have not been tested in the oncology clinical trial setting. We aimed to develop a targeted QPL for Clinical Trials (QPL-CT).

Methods

Breast, lung, and genitourinary cancer patients who either had (trial experienced) or had not (trial naive) participated in a clinical trial joined focus groups to help develop and explore the acceptability of a QPL-CT. Clinicians also participated in separated focus groups. Focus groups were audio-recorded and transcribed. We explored patients’ trial information needs and views about the utility of the QPL-CT.

Results

Patients focused on four trial information needs: understanding foundational information, conflict of interest issues and financial implications of trial participation. Of note, experienced patients need to personalize foundational information.

Conclusion

Patient information needs varied considerably and were influenced by trial experience. Patients valued the QPL-CT as an aid to gathering new trial information and ensuring that their information needs were met.

Practice implications

Physicians need to carefully elicit patient information needs and tailor trial information to meet these needs. The QPL-CT, may be of great benefit during clinical trial discussions.     

Discrepancy between patients’ use of and health providers’ familiarity with CAM

Objective

To compare patients’ complementary and alternative medicine (CAM) use and physicians’ familiarity with certain CAM modalities in the same setting and to assess patient–provider dialogue about patients’ CAM use.

Methods

An observational survey study with convenience sampling at ambulatory family medicine clinics in two Texas cities. A total of 69 healthcare providers and 468 patients completed the surveys. Patients’ surveys assessed use of 27 CAM therapies, perception of CAM use and interaction with providers. Providers’ survey assessed perception and attitude toward CAM use.

Results

CAM modalities most used by the patients are not those modalities that providers best understood. Of the 330 patients (70%) who responded to the relevant questions about discussing CAM, 44.5% reported never having discussed CAM use with their providers. Binomial logistic regression revealed no link between age, gender or ethnicity for discussing CAM with providers. College-educated patients (adjust OR = 2.8, 95%CI = 1.3–6.0) and US citizens were both about three times more likely to discuss CAM than their counterparts.

Conclusion

Lack of knowledge and unfamiliarity with CAM modalities might prevent important patient–provider discussions.

Practice implications

Providers should use existing resources and encourage a bilateral dialogue that involves transferring of information and assisting patients in decisions making about CAM use and health care.     

Communication matters: The impact of communication and participation in decision making on breast cancer patients’ depression and quality of life

Objective

This study explored the impact of breast cancer patients’ experiences of physician–patient communication and participation in decision making on patient depression and quality of life three and six months after primary treatment.

Methods

Participants were 135 German breast cancer patients, recruited within a week after the beginning of treatment. Women were asked to complete a self-administered questionnaire at baseline and three and six months later.

Results

Patients who rated their level of information at baseline as high were less depressed after three (p = .010) and six months (p < .001) and experienced higher quality of life after three (p < .001) and six months (p = .049). Patients who participated as much as they had wanted were more satisfied with the decision making process (p < .001) and had lower depression scores three months later (p = .005). The level of participation itself (passive, collaborative, active) and the treatment type had no impact.

Conclusion

The findings reveal the significance of physician–patient communication and stress the meaning of baseline depression for later adjustment.

Practice implications

A high level of information and tailoring the involvement in decision making to patients’ desired level can help patients to better cope with their illness. Physicians should assess and treat depression early in cancer treatment.     

Toward a greater understanding of breast cancer patients’ decisions to discuss cancer-related internet information with their doctors: An exploratory study

Objective

To investigate differences between breast cancer patients who do and do not discuss cancer-related internet information (CRII) with their doctors.

Methods

70 breast cancer patients completed questionnaires regarding internet use, discussions about CRII, and the doctor–patient relationship.

Results

No significant differences were noted across patient, disease, or visit characteristics, or physician reliance between those who intended to discuss CRII and those who did not. Patients who intended to discuss CRII rated significantly higher pre-consultation anxiety levels. No significant differences in satisfaction, anxiety reduction, or trust in physician were found between patients who had discussed and those who had not. Patients’ reasons for discussing or not discussing are detailed.

Conclusion

Factors influencing patients’ decisions to discuss CRII are complex and differ from those identified as leading patients to seek internet information. Future research about internet discussions should investigate the impact of patients’ preferred role in treatment, the doctor–patient relationship, anxiety level, attributes of CRII, and physician trust.

Practice implications

Understanding the characteristics of patients who do and do not discuss internet information is important given the impact internet information has on healthcare communication and the doctor–patient relationship, including the development of interventions aimed at improving such interactions.     

Nurse responsiveness to cancer patient expressions of emotion

Objective

This theoretically based study examined nurse responses to cancer patient expressions of emotion using a videotaped, simulated cancer patient.

Methods

This study used an experimental crossover design with a videotaped patient expressing anger, sadness, and neutral emotion to elicit nurse responses. Seventy-four nurses from eight sites participated. Responses were coded using Roter interaction analysis system. Correlations explored relationships between variables that impact communication (age, gender, work experience, trait anxiety, work stress, self-efficacy). Regression models explored the effect of variables on nurse affective responsiveness.

Results

Patient expressions of sadness elicited more affective responses than anger. Expressions of anger or neutral emotion elicited more instrumental behaviors than sadness. Variables such as age, work stress and work experience were significantly correlated. No variables predicted affective responsiveness to patient expressions of anger or sadness.

Conclusion

Nurse communication showed significant variation in response to patient emotional expressions. Understanding the relationships between demographic, personality, and work variables, and identification of new variables that influence nurse–patient communication, has implications for interventional studies.

Practice implications

Over 90% of the participants indicated that the videotape simulation would be a useful method for teaching and practicing communication skills with patients expressing emotions.     

A feasibility study to evaluate breast cancer patients’ knowledge of their diagnosis and treatment

Objective

To evaluate the feasibility of an electronic survey to assess patients’ knowledge of their breast cancer and treatment, and interest in receiving a medical summary.

Methods

Women undergoing breast cancer treatment completed an interviewer-administered electronic survey in person or by telephone. Medical records were abstracted to evaluate knowledge accuracy.

Results

Among 38 eligible patients approached for the study, 35 (92%) participated and 33 (94%) completed the survey. Participants’ perceived knowledge tended to be greater than their actual knowledge. Reporting of clinicopathologic features was most accurate for stage (91%) and lymph node status (88%), and least accurate for tumor size (61%), type (61%), and grade (33%). Accurate reporting of tumor receptor over-expression varied from 76% (estrogen receptor) to 39% (progesterone receptor). Many patients correctly recalled general treatment modalities and details of surgery; fewer recalled details of radiation and chemotherapy. Importantly, nearly all (32/33) were interested in receiving a breast cancer medical summary.

Conclusion

An electronic survey is feasible to assess breast cancer patients’ knowledge. This data suggest that patients have gaps in knowledge and would like a personalized medical summary.

Practice implications

Larger studies are needed to validate and characterize knowledge gaps, and test interventions to improve physician–patient information sharing.     

Breast cancer patients’ trust in physicians: The impact of patients’ perception of physicians’ communication behaviors and hospital organizational climate

Objective

To examine whether patients’ perception of a hospital's organizational climate has an impact on their trust in physicians after accounting for physicians’ communication behaviors as perceived by the patients and patient characteristics.

Methods

Patients undergoing treatment in breast centers in the German state of North Rhein-Westphalia in 2006 were asked to complete a standardized postal questionnaire. Disease characteristics were then added by the medical personnel. Multiple linear regressions were performed.

Results

80.5% of the patients responded to the survey. 37% of the variance in patients’ trust in physicians can be explained by the variables included in our final model (N = 2226; R² adj. = 0.372; p < 0.001). Breast cancer patients’ trust in their physicians is strongly associated with their perception of a hospital's organizational climate. The impact of their perception of physicians’ communication behaviors persists after introducing hospital organizational characteristics. Perceived physician accessibility shows the strongest association with trust.

Conclusions

A trusting physician–patient relationship among breast cancer patients is associated with both the perceived quality of the hospital organizational climate and perceived physicians’ communication behaviors.

Practice implications

With regard to clinical organization, efforts should be put into improving the organizational climate and making physicians more accessible to patients.     

Use of and reactions to a tailored CD-ROM designed to enhance oncologist–patient communication: The SCOPE trial intervention

Objective

Assess use of and reactions to an interactive, tailored CD-ROM to enhance oncologist–patient communication.

Methods

Participating oncologists (n = 48) agreed to have patient interactions audio recorded, be randomly assigned to receive/not receive a CD-ROM, have CD-ROM usage monitored (intervention group) and complete a follow-up survey.

Results

Twenty-one of 24 in the intervention group reported using the CD-ROM. Median usage minutes were 63.8. At follow-up, oncologists rated the CD-ROM from 1 (“none” or “not at all helpful”) to 5 (“a great deal” or “very helpful”). Mean responses were: 3.1 and 3.0 for 2 items assessing perceived impact on communications, 3.8–4.0 for 6 items assessing perceived helpfulness, 3.0 and 3.10 for 2 items assessing impact on affecting oncologists’ communication with patients and assistance with challenging conversations, respectively, and 3.6 for whether using the CD-ROM was worth their time. Self-report of how much oncologists had used the covered skills before and after intervention showed a perceived increase (2.8 before and 3.2 after).

Conclusions

Findings suggest the tailored interactive CD-ROM has promise for use and acceptance among oncologists.

Practice implications

If ultimately found effective in changing oncologist's communication with patients, the CD-ROM's widespread dissemination should be explored.     

Teen CHAT: Development and utilization of a web-based intervention to improve physician communication with adolescents about healthy weight

Objective

To describe the theoretical basis, use, and satisfaction with Teen CHAT, an online educational intervention designed to improve physician–adolescent communication about healthy weight.

Methods

Routine health maintenance encounters between pediatricians and family practitioners and their overweight adolescent patients were audio recorded, and content was coded to summarize adherence with motivational interviewing techniques. An online educational intervention was developed using constructs from social cognitive theory and using personalized audio recordings. Physicians were randomized to the online intervention or not, and completed post-intervention surveys.

Results

Forty-six physicians were recruited, and 22 physicians were randomized to view the intervention website. The educational intervention took an average of 54 min to complete, and most physicians thought it was useful, that they would use newly acquired skills with their patients, and would recommend it to others. Fewer physicians thought it helped them address confidentiality issues with their adolescent patients.

Conclusion

The Teen CHAT online intervention shows potential for enhancing physician motivational interviewing skills in an acceptable and time-efficient manner.

Practice implications

If found to be effective in enhancing motivational interviewing skills and changing adolescent weight-related behaviors, wide dissemination will be feasible and indicated.     

Development and pilot testing of a novel education method for training medical interpreters

Objective

The goal of this study was to determine core competencies by means of a systematic literature review and to design and test an interpreter training program.

Methods

Core competencies in medical interpreting were searched using a systematic literature review. An intervention program was developed to improve core competencies. Pretests and posttests were conducted to pilot-test knowledge and interpreting skills in participants aged 22–62 years (n = 43). Results of the tests were compared.

Results

Results of the systematic review indicated five core competencies: (a) maintaining accuracy and completeness; (b) medical terminology and understanding the human body; (c) behaving ethically and making ethical decisions; (d) nonverbal communication skills; and (e) cross-cultural communication skills. Statistical analysis showed a significant improvement in knowledge and interpreting skills in the intervention program compared with the control program.

Conclusion

Posttest assessment showed that the developed training system can be useful in improving knowledge and quality in medical interpreting.

Practice implications

A 3-day training program for medical interpreters could bridge the gap between medical professionals and patients with limited English proficiency while being amenable to integration into clinical flow.     

Postoperative information needs and communication barriers of esophageal cancer patients

Objective

Given the poor prognosis of esophageal cancer and the impact of surgery on health-related quality of life (HRQL), addressing patients’ postoperative information needs is important. This study aimed to examine (1) the content and type of patients’ information needs and (2) patient perceived facilitators and barriers to patient participation.

Methods

Interviews were conducted with 20 purposefully selected esophageal cancer patients. Open and structured questions were alternated. The transcribed interviews were analysed inductively and deductively, using MAXqda.

Results

Patients’ post-operative information needs concerned HRQL, medical care and prognosis, covering several sub-domains. Different types of needs were identified, e.g., requests for information about cause, course and self-management. Barriers to patient participation mostly reflected beliefs and skills, and could be categorized into agenda and communication barriers. Facilitators of patient participation reflected physician, patient and interaction characteristics, companion support and pre-visit preparation. Many patients saw merit in pre-visit preparation interventions; few endorsed skill-building interventions.

Conclusion

This study listed the postoperative information needs of esophageal cancer patients. Moreover, it gained insight into patient-perceived barriers and facilitators of patient participation.

Practice implications

The findings demonstrate what information physicians should have available and informs interventions to support patients in meeting their information needs.     

A comparison of GP,pharmacist and nurse prescriber responses to patients’ emotional cues and concerns in primary care consultations

Objective

Recognising patients’ cues and concerns is an important part of patient centred care. With nurses and pharmacists now able to prescribe in the UK, this study compared the frequency, nature, and professionals’ responses to patient cues and concerns in consultations with GPs, nurse prescribers and pharmacist prescribers.

Methods

Audio-recording and analysis of primary care consultations in England between patients and nurse prescribers, pharmacist prescribers and GPs. Recordings were coded for the number of cues and concerns raised, cue or concern type and whether responded to positively or missed.

Results

A total of 528 consultations were audio-recorded with 51 professionals: 20 GPs, 19 nurse prescribers and 12 pharmacist prescribers. Overall there were 3.5 cues or concerns per consultation, with no difference between prescriber groups. Pharmacist prescribers responded positively to 81% of patient's cues and concerns with nurse prescribers responding positively to 72% and GPs 53% (PhP v NP: U = 7453, z = −2.1, p = 0.04; PhP v GP: U = 5463, z = −5.9, p < 0.0001; NP v GP: U = 12,070, z = −4.9, p < 0.0001).

Conclusion

This evidence suggests that pharmacists and nurses are responding supportively to patients’ cues and concerns.

Practice implications

The findings support the importance of patient-centredness in training new prescribers and their potential in providing public health roles.     

Consultation support for rural women with breast cancer: Results of a community-based participatory research study

Objective

This study asked: (1) What do rural women with breast cancer need to make the most out of their major medical appointments? and (2) What can the community resource centers do to best support those needs?

Methods

We interviewed 12 doctors, 12 breast cancer survivors and 10 community agency staff, including those who provide services to Latinos and Native Americans. Interviews generated success factors and barriers related to meeting patient information needs. Examples were categorized into themes.

Results

Success factors included making sure patients review high quality educational materials before the visit; and that someone is available to take notes. Doctors felt that a patient list of questions was productive, but some survivors felt doctors did not always respond productively to the list. Respondents did not mention audiorecording unless prompted. Most then endorsed it.

Conclusion

Educational materials, question lists, and note-takers can help rural women with breast cancer and their doctors achieve their goals during treatment discussions. Audiorecording may be an implicit but not explicit need.

Practice implications

Other cancer resource centers and support agencies should consider offering information, question-listing, and note-taking services. They should assess whether audiorecording is an implicit need in their settings.     

Patient and observer ratings of physician shared decision making behaviors in breast cancer consultations

Objective

Explore the validity of using patient reports to measure shared decision making (SDM).

Methods

178 patients diagnosed with breast cancer obtained SDM assistance in a university-based clinic. Trained observers rated physician SDM behaviors and surveyed patients. We calculated the frequency with which patients and observers reported maximum SDM behaviors for each survey item. We also calculated agreement frequency between patients and observers.

Results

Over 90% of patients rated doctors as reflecting SDM competencies. Patients reported doctors making recommendations more than soliciting their preferred choice (90% vs. 69%, p < 0.001). Patients heard benefits discussed “a lot” more often than they heard risks and side effects discussed “a lot” (81% vs. 58%, p < 0.001). Agreement between patients and observers was 75%. In cases of disagreement, patients more frequently perceived SDM behaviors than did observers (15% vs. 9%, p = 0.002), suggesting a possible agreement bias.

Conclusions

High agreement supports further investigation into using patients as efficient and effective raters of SDM. Patient ratings may be inflated by agreement bias.

Practice implications

Doctors presentations may be biased toward discussing benefits more than risks. Policy makers can solicit patient ratings of SDM as long as they are aware of possibly inflated ratings due to agreement bias.     

Effects of using online narrative and didactic information on healthcare participation for breast cancer patients

OBJECTIVES: To determine the effects of online narrative and didactic information on breast cancer patients' healthcare participation and the interaction effects of race. METHODS: Sample: 353 breast cancer patients (111 African Americans) using an eHealth program with narratives (audiovisual and text) and didactic information (text only). Measures: healthcare participation scale (0, 4 months), online information use. Analyses: hierarchical regression. RESULTS: Narrative (beta=0.123, p<0.01) and didactic (beta=0.104, p<0.05) information use had independent and positive effects on healthcare participation. Effects of both were significantly greater for African Americans. CONCLUSIONS: Findings are consistent with and advance prior research on online learning processes and outcomes for breast cancer patients: (1) benefits accrue with using a variety of online learning tools; (2) African Americans use and benefit more from online narrative and didactic information than do Caucasians. PRACTICE IMPLICATIONS: eHealth programs should provide both didactic and narrative information-especially for African Americans and might consider making greater use of interactive and audiovisual formats. As patients increasingly use of the web for cancer information, clinicians should provide lists of web high quality resources that provide both narrative and didactic information.     

Examining patients’ trust in physicians and the VA healthcare system in a prospective cohort followed for six-months after an exacerbation of heart failure

Objective

To examine the associations of several characteristics with patients’ trust in physician and the healthcare system.

Methods

A prospective cohort of patients were followed after an exacerbation of heart failure at one of two veterans affairs (VA) hospitals. Patients rated pre-visit and post-visit trust in physician and in the VA healthcare system at follow-up outpatient visits. The associations of trust in physician and VA with covariates were analyzed using multivariate mixed-effects regression.

Results

After adjusting for covariates, post-visit trust in physician was significantly higher than pre-visit trust (P < 0.001), but was not significantly different by race. Trust in VA did not change significantly over time (P > 0.20), but was significantly lower for Black patients (P < 0.001). High self-efficacy to communicate was independently associated with both trust in physician and VA (P < 0.001).

Conclusions

Trust in physician improved over the course of each visit. Trust in VA was not associated with time, but was lower among Black patients. Trust was higher when ratings of communication were higher.

Practice implications

Trust in physician improved at each visit and was independently associated with communication. Interventions designed to improve communication should be tested for their ability to improve trust in physician and trust in the healthcare system.     

Feasibility of a team based prognosis and treatment goal discussion (T-PAT) with women diagnosed with advanced breast cancer

Objective

To assess the feasibility of a team-based prognosis and treatment goal discussion for women living with advanced breast cancer.