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

The oncologist

article

Inge Henselmans¹  Geert-Jan Creemers⁴  Filip Y.F.L. de Vos⁵  Ellen M.A. Smets¹  Hanneke W.M. van Laarhoven⁶  Pomme van Maarschalkerweerd¹  Hanneke C.J.M. de Haes¹  Marcel G.W. Dijkgraaf⁷  Dirkje W. Sommeijer⁶  Petronella B. Ottevanger⁸  Helle-Brit Fiebrich⁴  Serge Dohmen⁴ 

[1] Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam;Amsterdam Public Health Research Institute;Cancer Center Amsterdam;Department of Medical Oncology;Department of Medical Oncology, University Medical Center Utrecht;Department of Medical Oncology, Amsterdam University Medical Centers, University of Amsterdam;Department of Clinical Epidemiology, Amsterdam University Medical Centers, University of Amsterdam;Department of Medical Oncology, Radboud University Medical Center

关键词: Shared decision making;    Advanced cancer;    Palliative medicine;    Systemic treatment;    Doctor-patient communication;    Patient participation;    Patient education;    Communication skills training;   

DOI  :  10.1634/theoncologist.2019-0453

学科分类：地质学

来源: AlphaMed Press Incorporated

【 摘 要 】

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.

【 授权许可】

CC BY|CC BY-NC