The Question‐prompt list (QPL): Why it is needed in the Indian oncology setting?

Abstract

Background In India, caregivers are an integral part of the illness experience, especially in cancer, to the extent that they can become proxy decision‐makers for the patient. Further, owing to acute resource constraints in the Indian healthcare system, it may be difficult for oncologists to assess and elicit questions from each patient/caregiver. Consequently, there is a need to address these unique aspects of oncology care in India to improve patient outcomes and understanding of their illness and treatment. This can be achieved through a Question Prompt List (QPL), a checklist used by care recipients during medical consultations. Recent Findings This narrative review will first introduce research on the development and effectiveness of the QPL, and then it will highlight current gaps in oncology care in India and explore how the QPL may aid in closing these gaps. A literature search of the empirical research focused on the development, feasibility and acceptability of the QPL in oncology settings was conducted. The final review included 40 articles pertaining to QPL research. Additionally, psycho‐oncology research in India centered on information needs and experiences was reviewed. Current Indian psycho‐oncology research reports patients' want to be actively involved in their cancer care and a need for more illness information. However, a high demand on physicians' resources and the family caregivers' interference can be barriers to meeting patients' information/communication needs. International research demonstrates that a QPL helps structure and decrease consultation time, improves patient satisfaction with care, and improves the quality of communication during medical encounters. Conclusion QPLs for Indian patients and caregivers may focus on the scope of medical consultations to address patient needs while influencing the course and content of the patient‐caregiver‐physician interactions. Further, it can address the resource constraints in Indian oncology care settings, thus reducing the physician's burden.

Development of a question prompt list for Indian cancer patients receiving radiation therapy treatment and their primary family caregivers

“…Due to the high rates of diagnosis nondisclosure in India, 7 the word cancer was not included in the Patient QPL draft. Questions were framed using Indian English, 5 as commonly spoken in India.…”

Nurse‐led telephone notification of a prostate cancer diagnosis: Prospective analysis of men's preferences for and experiences of a same‐day assessment and diagnostic clinic

“…The OSPC itself and the role and responsibilities of the OSPC CN were quite unique at our institution. In the course of the conversation Rights, respect and dignity --with men informing of their cancer diagnosis, men were directed to appropriate prostate cancer resources and encouraged to develop their own question prompt list to enrich and derive increased benefit from their discussion with the specialist (Chawak et al, 2020;Dimosaka et al, 2012;McJannet et al, 2003). The OSPC CN role ensured that no one was lost to follow-up and demonstrates the vital support that specialist cancer nurses can provide to medical practitioners and patients in the oncology setting, as demonstrated in nurse-led follow-up clinics for prostate cancer (Casey et al, 2017;Martin et al, 2018).…”

Experiences of barriers to self-monitoring and medication-management among Indian patients with type 2 diabetes, their primary family-members and physicians

“…Used in a variety of chronic conditions and multicultural medical settings, the QPL is observed to reduce patients’ inhibitions in question-asking. 13 Therefore, it is possible that a triadic model which is initiated by the physician and inclusive of the family along with a QPL which encourages patients' question-asking behaviors may be more appropriate in empowering for Indian patients.…”

“…Therefore, triadic communication may be particularly useful in western countries where physicians receive communication skills training and are faced with patients from several cultural backgrounds. In India, the triadic model of communication may need to be coupled with methods which directly empower patients such as the question prompt list (QPL 13 ) The QPL is a checklist of potential concerns/worries/questions that patients may have regarding one's illness and would like to ask the physician during their consultation. Used in a variety of chronic conditions and multicultural medical settings, the QPL is observed to reduce patients' inhibitions in question-asking.…”

“…In India, decision-making is physician-led with minimal input from family caregivers (patients are often discouraged from involvement). 13,14 Patient-focused education (e.g. DESMOND; SIDEP) help patients obtain skills to self-manage diabetes.…”