A systematic review of interventions aiming to improve communication of prognosis to adult patients

Selim, Shehab; Kunkel, Elizabeth; Wegier, Pete; Tanuseputro, Peter; Downar, James; Isenberg, Sarina R.; Li, Aimee; Kyeremanteng, Kwadwo; Dujovny, Manuel; Kobewka, Daniel

doi:10.1016/j.pec.2020.02.029

Cited by 9 publications

(4 citation statements)

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“…Owing to consecutive sampling, information will be available about the number of patients willing to use the QPL and the number of oncologists who will engage in its use during consultations [ 92 ]. Furthermore, the resulting QPL will be pilot-tested on outcomes such as patients’ beliefs about primary cancer treatment goals or satisfaction with the information provided about prognosis and treatment, which are important [ 93 ] and previously lacking effect measurement of QPL use [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…Information on prognosis and treatment outcomes is important for achieving a shared perception of the disease status and treatment goals between patients and oncologists [ 2 - 4 ]. A general population survey performed in 7 European countries indicates that 73% of citizens prefer to be informed in case of a poor disease prognosis (≤1 year to live) [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…A general population survey performed in 7 European countries indicates that 73% of citizens prefer to be informed in case of a poor disease prognosis (≤1 year to live) [ 5 ]. In the advanced cancer setting, most patients want a realistic understanding of their current condition and life expectancy; however, not all wish to receive exact or definitive time frames [ 2 , 6 - 9 ]. Oncologists have difficulty appraising patients’ information preferences [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Helping Patients Communicate With Oncologists When Cancer Treatment Resistance Occurs to Develop, Test, and Implement a Patient Communication Aid: Sequential Collaborative Mixed Methods Study

Brédart¹,

Terrasson²,

Seigneur³

et al. 2022

JMIR Res Protoc

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Background Most cancer-related deaths result from disseminated diseases that develop resistance to anticancer treatments. Inappropriate communication in this challenging situation may result in unmet patient information and support needs. Patient communication aids such as question prompt lists (QPLs) may help. Objective This study aims to develop and pilot-test a specific QPL in the following two contrasting clinical contexts in France after cancer resistance has developed: triple-negative and luminal B metastatic breast cancer (MBC) and metastatic uveal melanoma (MUM). Methods A sequential study design with a mixed methods collaborative approach will be applied. The first step aims to build a specific QPL. Step 1a will explore oncologist-patient communication issues from oncology professionals’ interviews (n=20 approximately). Step 1b will appraise information and support needs experienced by patients with MBC or MUM both quantitatively (n=80) and qualitatively (n=40 approximately). These data will be used to develop and pilot-test a QPL specific to patients with cancer experiencing initial or acquired resistance to treatment. We expect to obtain a core QPL that comprises questions and concerns commonly expressed by patients with resistant cancer and is complemented by specific issues for either MBC or MUM cancer sites. In step 1c, 2 focus groups of patients with any type of metastatic cancer (n=4) and health care professionals (n=4) will be conducted to revise the content of a preliminary QPL and elaborate an acceptable and feasible clinical implementation. In step 1d, the content of the QPL version 1 and implementation guidance will be validated using a Delphi process. Step 2 will pilot-test the QPL version 1 in real practice with patients with MBC or MUM (n=80). Clinical utility will be assessed by comparing responses to questionnaires administered in step 1b (QPL-naive historical control group) and step 2 (QPL intervention group). Results This study received grants in March and December 2019 and was approved by the French national ethics committee in July 2019. As of October 2021, interviews with oncology professionals have been conducted and analyzed (N=26 to reach saturation), and 39 and 27 patients with MBC and MUM, respectively, have been recruited. Conclusions A clinically and culturally tailored QPL is expected to facilitate patients’ participation in consultations, improve oncologists’ responses to patients’ information and support needs, and thus foster patients’ psychological adjustment to the diagnosis and follow-up of cancer resistance to treatment. Trial Registration ClinicalTrials.gov NCT04118062; http://clinicaltrials.gov/ct2/show/NCT04118062 International Registered Report Identifier (IRRID) DERR1-10.2196/26414

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Helping Patients Communicate With Oncologists When Cancer Treatment Resistance Occurs to Develop, Test, and Implement a Patient Communication Aid: Sequential Collaborative Mixed Methods Study

Brédart¹,

Terrasson²,

Seigneur³

et al. 2022

JMIR Res Protoc

View full text Add to dashboard Cite

show abstract

“…Prognosis-related communication, also known as truth-telling or breaking bad news, is a continuous process that encompasses discussing life expectancy, symptom progression, and functional abilities with patients, their families, and healthcare professionals [1]. Effective discussion about prognosis facilitates informed decisions for patients and enhances patient-reported outcomes [2]. Despite the expectation that prognosis communication should be a standard practice and a universal communication ideal in healthcare, clinicians, including nurses, experience discomfort and concerns in breaking bad news.…”

Section: Prognosis-related Communication: Ethical Dilemmas Among the ...mentioning

confidence: 99%

Prognosis-Related Communication: Ethical Dilemmas Among the Oncology Nurses in China (Preprint)

Ko,

Shamsalizadeh,

Lee

et al. 2024

Preprint

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BACKGROUND Effective communication about prognosis is imperative for enhancing the quality of end-of-life care and improving patient well-being. This practice is sensitive and is heavily influenced by cultural values, beliefs, and norms. This can lead to ethical dilemmas. Despite their significance, ethical challenges in nursing practice relating to prognosis communication are understudied in China. OBJECTIVE This study aimed to examine the ethical dilemmas relating to prognosis communication and their associated factors. METHODS A cross-sectional design was employed to survey 373 oncology nurses in mainland China via online. Data were collected on ethical dilemmas, attitudes, barriers, prognosis communication experiences, and socio-demographic and practice-related information. Ordinary least squares regression was utilized to identify the factors contributing to ethical dilemmas. RESULTS Participants reported a moderate level of ethical dilemmas in prognostic communication (M = 13.5, SD = 3.42, range = 5-20). Significant predictors of these dilemmas included perceived barriers (p < .001), prognosis communication experience (p < .001), and years of work experience (p = .002). Nurses who perceived greater barriers had more negative experiences with prognosis communication, and those with less work experience were more likely to encounter ethical dilemmas in prognosis-related communication CONCLUSIONS Chinese oncology nurses frequently encounter ethical dilemmas as well as barriers in prognosis communication. This study's findings emphasize the importance of culturally tailored communication training. Collaborative inter-professional training, particularly through physician-nurse partnerships, can perhaps enhance proficiency in prognosis-related communication.

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Evaluating surgeon communication of pancreatic cancer prognosis using the VitalTalk ADAPT framework

Dickerson,

Lipson,

Chauhan

et al. 2024

Journal of Surgical Oncology

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Background and ObjectivesFew data exist to guide optimal communication practices for surgical oncologists. VitalTalk, an evidence‐based communication skills training model for clinicians, offers the five‐step ADAPT tool for discussing prognosis. This study aimed to characterize surgeon communication of pancreatic cancer prognosis using VitalTalk's ADAPT framework.MethodsContemporaneous audio recordings from 12 initial surgeon–patient encounters for borderline resectable pancreatic cancer were transcribed. Directed qualitative content analysis based on ADAPT (Ask, Discover, Anticipate, Provide, and Track) was used to deductively code transcripts.ResultsAll encounters contained at least one ADAPT step while only one (8%) incorporated four or five steps. Surgeons provided prognostic information (Provide) in all but one encounter (92%); most was qualitative and clustered into themes: serious illness, surgical candidacy, prognostic ambiguity, and cancer recurrence. Surgeons elicited understanding (Ask), requested information preferences (Discover), anticipated ambivalence (Anticipate), and responded to emotion (Track) in a minority of encounters (25%–42%); of 15 patient emotional cues, six were not addressed by surgeons.ConclusionsDuring an initial encounter for pancreatic cancer, surgeons focus heavily on providing information but omit critical prognostic communication steps. Future studies are needed to investigate if surgeon training in palliative care‐based communication is feasible and impacts patient‐perceived quality of communication.

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A systematic review of interventions aiming to improve communication of prognosis to adult patients

Cited by 9 publications

References 45 publications

Helping Patients Communicate With Oncologists When Cancer Treatment Resistance Occurs to Develop, Test, and Implement a Patient Communication Aid: Sequential Collaborative Mixed Methods Study

Helping Patients Communicate With Oncologists When Cancer Treatment Resistance Occurs to Develop, Test, and Implement a Patient Communication Aid: Sequential Collaborative Mixed Methods Study

Prognosis-Related Communication: Ethical Dilemmas Among the Oncology Nurses in China (Preprint)

Evaluating surgeon communication of pancreatic cancer prognosis using the VitalTalk ADAPT framework

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