A Web‐based communication aid for patients with cancer

Abstract

Background Cancer patients and their oncologists often report differing perceptions of consultation discussions and discordant expectations regarding treatment outcomes. CONNECT™, a computer-based communication aid, was developed to improve communication between patients and oncologists. Methods CONNECT includes assessment of patient values, goals, and communication preferences; patient communication skills training; and a pre-consult physician summary report. CONNECT was tested in a three-arm, prospective, randomized clinical trial. Prior to the initial medical oncology consultation, adult patients with advanced cancer were randomized to (a) control; (b) CONNECT with physician summary, or (c) CONNECT without physician summary. Outcomes were assessed with post-consultation surveys. Results Of 743 patients randomized, 629 completed post-consultation surveys. Patients in the intervention arms (versus control) felt that the CONNECT program made treatment decisions easier to reach (p=0.003) and helped them to be more satisfied with these decisions (p<0.001). In addition, patients in the intervention arms reported higher levels of satisfaction with physician communication format (p=0.026) and discussion regarding support services (p=0.029) and quality of life concerns (p=0.042). The physician summary did not impact outcomes. Patients with higher levels of education and poorer physical functioning experienced greater benefit from CONNECT. Conclusion This prospective randomized clinical trial demonstrates that computer-based communication skills training can positively affect patient satisfaction with communication and decision making. Measureable patient characteristics may be used to identify subgroups most likely to benefit from an intervention such as CONNECT.

A Systematic Literature Review of Shared Decision Making in Cancer Care (Preprint)

“…Of the 23 studies included in this review, only three studies (13%) addressed elements of patient-clinician interaction as part of the study objectives or reported clinician training on how to implement the DA or incorporate SDM discussions into the consultation. [51,55,68] The number of SDM elements included in each study was relatively consistent over the ten-year review period which suggests that increased advocacy for SDM in cancer care over the past decade has not led to corresponding increases in the incorporation of key SDM elements. This finding also suggests that simply using a DA to present cancer treatment options and risks may not organically facilitate bi-directional SDM processes between patients and clinicians and further underscores the findings reported by Makoul and Clayman [42] that a common definition for SDM has been lacking across studies.…”

“…[55] An additional six studies [52,61,64,68,69,74] audio-recorded the patient-clinician interaction, but none reported analyzing the recordings. Only three studies [51,55,68] (13%) addressed elements of the patient-clinician interaction as part of the study objectives and included: (1) the impact of clinician proactivity in patient participation in rehabilitation; (2) whether clinicians provided more patient-centered responses when provided a summary of patient cues and concerns prior to consultation; and (3) whether a communication aid improved patient-clinician communication, respectively. Eighteen unique DAs were identified across the 23 studies.…”

A Literature Review of Patient Education: Is IT Time to Move Forward?

“…Five studies [10,37,[39][40][41] reported decision-making outcomes, with conflicting results (Table 5). Decisionmaking measures varied across studies.…”

“…On further multivariate analysis, they established CBLSs as the strongest predictor of satisfaction. Similarly, Meropol et al [10] reported increased satisfaction levels with CBLSs in cancer patients with various disease sites.…”

“…Early studies have reported health care professionals as patients' primary education sources [8][9][10]. Despite this, physicians and patients differ noticeably in perceptions of health priorities, and oncologist-patient communication can be suboptimal [11][12][13].…”