Objective
UK healthcare policy for improving cancer outcomes supports participation of patients in care decisions with clinicians. Consultation Planning, Recording and Summarising (CPRS) has shown evidence of increasing patient decision self‐efficacy, reducing uncertainty, and regret of decisions. This is the first trial of CPRS within the colorectal cancer population and delivered over serial medical consultations.
Methods
This randomised controlled trial compared usual care to the addition of CPRS over consecutive oncology consultations with newly diagnosed colorectal cancer (CRC) patients in Edinburgh, Scotland. The study primarily evaluated patients' perception of their decision self‐efficacy, preparation for decision‐making, decisional conflict, and decisional regret, with secondary measures of anxiety and depression.
Results
Compared with usual care, overall, the intervention group reported significantly higher decision self‐efficacy (P = 0.001) and preparation for decision‐making (P < 0.001) and significantly lower decisional conflict (P = 0.018) and regret (P = 0.039). The repeated intervention patients felt significantly better prepared for each consultation (P < 0.05); reported higher DSE before (P = 0.05) and after (P = 0.031) consultation one, and after consultation three (P = 0.004); and reported lower decisional conflict after consultation two (P = 0.007). Analyses comparing groups over time on decisional variables and anxiety and depression were underpowered because of attrition.
Conclusions
Among colorectal cancer patients, CPRS was associated with decisional benefits before and after each consultation and 3 months after the last consultation. It appears that CPRS patients began their first medical consultation on a better trajectory but did not widen the gap over time. More research is needed on the benefits of CPRS being administered once or consecutively.
Results suggest that Decision Navigation facilitated patients' involvement in treatment decision-making. Prostate patients engaging in preference-sensitive decision-making welcomed this approach to personalised tailored support.
Care home staff increasingly need to provide end-of-life care (EoLC), but rarely receive training in this. Jan Dobie, Marlis Plumb and Sarah Shepherd designed a study day for care workers to enable them to give residents high-quality, personalised EoLC
Older patients differ on information satisfaction showing a preference for doctors to make treatment decisions. For supportive care, there were few age differences; however, the SCNS sexuality and patient care and support domains indicate greater need in younger patients around the 3-month period following diagnosis. With a few exceptions, individual rather than age-specific needs determine supportive and informational care requirements.
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