Can communication between patients with advanced cancer and their oncologists be improved?
This cluster randomized clinical trial of communication training for oncologists paired with previsit coaching for patients showed clinically and statistically significant improvement in patient-centered communication.
Paired communication training for patients and oncologists helps achieve patient-centered care in advanced cancer: engaging patients in consultations (asking questions, expressing preferences), responding to emotions, and providing information about prognosis and treatment choices.
Observational studies demonstrate links between patient-centered communication, quality of life (QOL), and aggressive treatments in advanced cancer, yet few randomized clinical trials (RCTs) of communication interventions have been reported.
To determine whether a combined intervention involving oncologists, patients with advanced cancer, and caregivers would promote patient-centered communication, and to estimate intervention effects on shared understanding, patient-physician relationships, QOL, and aggressive treatments in the last 30 days of life.
Design, Setting, and Participants
Cluster RCT at community- and hospital-based cancer clinics in Western New York and Northern California; 38 medical oncologists (mean age 44.6 years; 11 (29%) female) and 265 community-dwelling adult patients with advanced nonhematologic cancer participated (mean age, 64.4 years, 146 [55.0%] female, 235 [89%] white; enrolled August 2012 to June 2014; followed for 3 years); 194 patients had participating caregivers.
Oncologists received individualized communication training using standardized patient instructors while patients received question prompt lists and individualized communication coaching to identify issues to address during an upcoming oncologist visit. Both interventions focused on engaging patients in consultations, responding to emotions, informing patients about prognosis and treatment choices, and balanced framing of information. Control participants received no training.
Main Outcomes and Measures
The prespecified primary outcome was a composite measure of patient-centered communication coded from audio recordings of the first oncologist visit following patient coaching (intervention group) or enrollment (control). Secondary outcomes included the patient-physician relationship, shared understanding of prognosis, QOL, and aggressive treatments and hospice use in the last 30 days of life.
Data from 38 oncologists (19 randomized to intervention) and 265 patients (130 intervention) were analyzed. In fully adjusted models, the intervention resulted in clinically and statistically significant improvements in the primary physician-patient communication end point (adjusted intervention effect, 0.34; 95% CI, 0.06-0.62; P = .02). Differences in secondary outcomes were not statistically significant.
Conclusions and Relevance
A combined intervention that included oncologist communication training and coaching for patients with advanced cancer was effective in improving patient-centered communication but did not affect secondary outcomes.
clinicaltrials.gov Identifier: NCT01485627
Ronald M. Epstein, Paul R. Duberstein, Joshua J. Fenton, Kevin Fiscella, Michael Hoerger, Daniel J. Tancredi, Guibo Xing, Robert Gramling, Supriya Mohile, Peter Franks, Paul Kaesberg, Sandy Plumb, Camille S. Cipri, Richard L. Street, Cleveland G. Shields, Anthony L. Back, Phyllis Butow, Adam Walczak, Martin Tattersall, Alison Venuti, Peter Sullivan, Mark Robinson, Beth Hoh, Linda Lewis, Richard L. Kravitz. Effect of a Patient-Centered Communication Intervention on Oncologist-Patient Communication, Quality of Life, and Health Care Utilization in Advanced CancerThe VOICE Randomized Clinical Trial. JAMA Oncol. 2017;3(1):92–100. doi:10.1001/jamaoncol.2016.4373