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

Abstract

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.

Stronger therapeutic alliance is associated with better quality of life among patients with advanced cancer

“…Efforts to enhance therapeutic alliance should target both patients and oncologists as both groups contribute to the overall bond. Recent studies that tested combined patient and oncologist interventions to improve communication and shared decision‐making among cancer patients can assist researchers in developing therapeutic alliance interventions 29,30 . As oncologists engage in communication skills training, they will gain skills to support patients in improving patient outcomes 31,32 .…”

Patient and physician shared decision making behaviors in oncology: Evidence on adequate measurement properties of the iSHARE questionnaires

“…A clear indication that our sample suffered from some form of selection bias were the remarkably high scores on the other questionnaires too. Two recent studies in Dutch cancer patients [38, 39] showed substantially lower SDM-Q-9 scores and higher decisional conflict scores. In addition, two recent studies in Dutch cancer patients [40] and Dutch cancer survivors [41] showed somewhat lower patients’ perceived self-efficacy compared to our sample.…”

Educational interventions for shared decision making and the role of patient agency: A Systematic Review

“…(OPTION) scale or an adapted version (e.g., OPTION 5), was used in five studies 16,17,26,31,34,37,38 . The extent to which providers were observed involving patients in shared decision making was considered an outcome in all these studies 39 .…”