A systematic review of evidence for end-of-life communication interventions: Who do they target, how are they structured and do they work?

Walczak, Adam; Butow, Phyllis; Bu, Stella; Clayton, Josephine M.

doi:10.1016/j.pec.2015.08.017

Cited by 137 publications

(127 citation statements)

References 71 publications

Supporting

Mentioning

115

Contrasting

Unclassified

Order By: Relevance

“…Similarly, a randomised controlled study implementing a question prompt list for consecutive patients with advanced cancer increased discussion of end-of-life issues 57. These successes are in line with the suggestion of Walczak et al 58 that multifaceted interventions may be more effective than training alone. Such efforts to normalise end-of-life discussions by embedding them within routine practice, in combination with training and support for clinicians, may help them occur sooner and more frequently.…”

Section: What Can We Do To Improve End-of-life Care Communication?supporting

confidence: 55%

Communication in palliative care: talking about the end of life, before the end of life

Brighton

Bristowe

2016

Postgraduate Medical Journal

258

232

View full text Add to dashboard Cite

Increasing evidence demonstrates the benefits of early end-of-life care discussions with patients with lifethreatening illness and their families. However, these conversations often do not occur. This review explores some of the many barriers faced by clinicians in relation to end-of-life care discussions, including prognostic uncertainty, fear of causing distress, navigating patient readiness and feeling unprepared for these conversations. The value of core clinical communication skills, potential strategies for improvement and areas for future research are also discussed. It is essential that clinicians offer patients facing life-threatening illness, and those close to them, the opportunity to discuss end-of-life issues in line with their information and decision-making preferences. With a growing and ageing global population, supporting both generalist and specialist providers of palliative care in this task is key. With careful preparation, fears of undertaking these discussions should not be a barrier to initiating them.

show abstract

Section: What Can We Do To Improve End-of-life Care Communication?supporting

confidence: 55%

Communication in palliative care: talking about the end of life, before the end of life

Brighton

Bristowe

2016

Postgraduate Medical Journal

258

232

View full text Add to dashboard Cite

show abstract

“…In our trial, the interventions did not affect patients' quality of life 3 months after the consultation in which a treatment decision was made. Several reviews have called for more robust studies to examine the effect of communication interventions [25,60,61]. The current trial meets this call.…”

Section: Discussionmentioning

confidence: 96%

“…Several reviews have called for more robust studies to examine the effect of communication interventions . The current trial meets this call.…”

Section: Discussionmentioning

confidence: 98%

“…The same holds for training specifically focused on SDM [21][22][23]. Besides physician training, there is growing interest in patient-targeted communication interventions [24,25], such as prompt lists [26][27][28][29][30] and decision aids to increase patient participation [31][32][33][34]. Few studies have examined the combination of physician training with patient-targeted interventions on SDM in palliative cancer care [35].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effect of a Skills Training for Oncologists and a Patient Communication Aid on Shared Decision Making About Palliative Systemic Treatment: A Randomized Clinical Trial

et al. 2019

View full text Add to dashboard Cite

Background Palliative systematic treatment offers uncertain and often limited benefits, and the burden can be high. Hence, treatment decisions require shared decision making (SDM). This trial examined the independent and combined effect of an oncologist training and a patient communication aid on SDM. Methods In this multicenter randomized controlled trial with four parallel arms (2016–2018), oncologists (n = 31) were randomized to receive SDM communication skills training or not. The training consisted of a reader, two group sessions, a booster session, and a consultation room tool (10 hours). Patients (n = 194) with advanced cancer were randomized to receive a patient communication aid or not. The aid consisted of education on SDM, a question prompt list, and a value clarification exercise. The primary outcome was observed SDM as rated by blinded observers from audio‐recorded consultations. Secondary outcomes included patient‐reported SDM, patient and oncologist satisfaction, patients’ decisional conflict, patient quality of life 3 months after consultation, consultation duration, and the decision made. Results The oncologist training had a large positive effect on observed SDM (Cohen's d = 1.12) and on patient‐reported SDM (d = 0.73). The patient communication aid did not improve SDM. The combination of interventions did not add to the effect of training oncologists only. The interventions affected neither patient nor oncologist satisfaction with the consultation nor patients’ decisional conflict, quality of life, consultation duration, or the decision made. Conclusion Training medical oncologists in SDM about palliative systemic treatment improves both observed and patient‐reported SDM. A patient communication aid does not. The incorporation of skills training in (continuing) educational programs for medical oncologists is likely to stimulate the widely advocated uptake of shared decision making in clinical practice. Trial registration. Netherlands Trial Registry NTR 5489. Implications for Practice Treatment for advanced cancer offers uncertain and often small benefits, and the burden can be high. Hence, treatment decisions require shared decision making (SDM). SDM is increasingly advocated for ethical reasons and for its beneficial effect on patient outcomes. Few initiatives to stimulate SDM are evaluated in robust designs. This randomized controlled trial shows that training medical oncologists improves both observed and patient‐reported SDM in clinical encounters (n = 194). A preconsultation communication aid for patients did not add to the effect of training oncologists. SDM training effectively changes oncologists’ practice and should be implemented in (continuing) educational programs.

show abstract

“…[58][59][60][61][62][63] Reviews also featured carers of people with stroke, 64,65 carers of people with mental health problems 66,67 and carers of people with various conditions. [68][69][70][71][72] In reviews that included primary studies of carers of people with different conditions, carers of patients at the end of life were represented, 69,71,72 as were carers of people with conditions including cancer, stroke, dementia and cardiovascular disease. 68,70 The types of interventions reported in the medium-quality reviews were broadly similar to those reported in the high-quality reviews.…”

Section: Overview Of the Medium-quality Reviewsmentioning

confidence: 99%

Updated meta-review of evidence on support for carers

Thomas

Dalton

Harden

et al. 2017

Health Serv Deliv Res

View full text Add to dashboard Cite

BackgroundPolicy and research interest in carers continues to grow. A previous meta-review, published in 2010, by Parkeret al.(Parker G, Arksey H, Harden M.Meta-review of International Evidence on Interventions to Support Carers. York: Social Policy Research Unit, University of York; 2010) found little compelling evidence of effectiveness about specific interventions and costs.ObjectiveTo update what is known about effective interventions to support carers of ill, disabled or older adults.DesignRapid meta-review.SettingAny relevant to the UK health and social care system.ParticipantsCarers (who provide support on an unpaid basis) of adults who are ill, disabled or older.InterventionsAny intervention primarily aimed at carers.Main outcome measuresAny direct outcome for carers.Data sourcesDatabase searches (including Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, MEDLINE, Applied Social Sciences Index and Abstracts and Social Care Online) for systematic reviews published from January 2009 to 2016.Review methodsWe used EndNote X7.4 (Thomson Reuters, CA, USA) to screen titles and abstracts. Final decisions on the inclusion of papers were made by two reviewers independently, using a Microsoft Excel®2013 spreadsheet (Microsoft Corporation, Redmond, WA, USA). We carried out a narrative synthesis structured by patient condition and by seven outcomes of interest. We assessed the quality of the included systematic reviews using established criteria. We invited a user group of carers to give their views on the overall findings of our review.ResultsSixty-one systematic reviews were included (27 of high quality, 25 of medium quality and nine of low quality). Patterns in the literature were similar to those in earlier work. The quality of reviews had improved, but primary studies remained limited in quality and quantity. Of the high-quality reviews, 14 focused on carers of people with dementia, four focused on carers of those with cancer, four focused on carers of people with stroke, three focused on carers of those at the end of life with various conditions and two focused on carers of people with mental health problems. Multicomponent interventions featured prominently, emphasising psychosocial or psychoeducational content, education and training. Multiple outcomes were explored, primarily in mental health, burden and stress, and well-being or quality of life. Negative effects following respite care were unsupported by our user group. As with earlier work, we found little evidence on intervention cost-effectiveness. No differences in review topics were found across high-, medium- and low-quality reviews.LimitationsThe nature of meta-reviews precludes definitive conclusions about intervention effectiveness, for whom and why. Many of the included reviews were small in size and authors generally relied on small numbers of studies to underpin their conclusions. The meta-review was restricted to English-language publications. Short timescales prevented any investigation of the overlap of primary studies, and growth in the evidence base since the original meta-review meant that post-protocol decisions were necessary.ConclusionsThere is no ‘one size fits all’ intervention to support carers. Potential exists for effective support in specific groups of carers. This includes shared learning, cognitive reframing, meditation and computer-delivered psychosocial support for carers of people with dementia, and psychosocial interventions, art therapy and counselling for carers of people with cancer. Counselling may also help carers of people with stroke. The effectiveness of respite care remains a paradox, given the apparent conflict between the empirical evidence and the views of carers.Future workMore good-quality, theory-based, primary research is warranted. Evidence is needed on the differential impact of interventions for various types of carers (including young carers and carers from minority groups), and on the effectiveness of constituent parts in multicomponent programmes. Further research triangulating qualitative and quantitative evidence on respite care is urgently required. The overlap of primary studies was not formally investigated in our review, and this warrants future evaluation.Study registrationThis study is registered as PROSPERO CRD42016033367.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

show abstract

A systematic review of evidence for end-of-life communication interventions: Who do they target, how are they structured and do they work?

Cited by 137 publications

References 71 publications

Communication in palliative care: talking about the end of life, before the end of life

Communication in palliative care: talking about the end of life, before the end of life

Effect of a Skills Training for Oncologists and a Patient Communication Aid on Shared Decision Making About Palliative Systemic Treatment: A Randomized Clinical Trial

Updated meta-review of evidence on support for carers

Contact Info

Product

Resources

About