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Abstract
Despite hospital palliative care consultations during which goals of care are discussed in the context of poor prognoses, older adults are admitted to nursing homes for post-acute care where the focus is on rehabilitation. The purpose of this qualitative descriptive study was to describe factors that influence discontinuity between a palliative care consult and nursing home care and explore the potential consequences of this discontinuity. Twelve adults (mean age of 80 years) were enrolled from one community hospital and nursing home in the mid-Atlantic United States. Semi-structured interviews and medical record reviews were used to elicit information about clinical course, care processes, and patient/family preferences at hospital discharge and up to four times after nursing home admission. Data were analyzed using inductive content analysis techniques. Analysis revealed two themes: Inadequate Communication characterized by the lack of information about the palliative care consult after hospital discharge and Prognosis Incongruence evidenced by data demonstrating a discrepancy between hospital prognosis and nursing home care. Ongoing communication between settings to re-address goals of care, prognosis, and symptoms-the central tenets of palliative care-is lacking. Efforts to improve access to comprehensive palliative care delivery after hospitalization and during nursing home transitions are greatly needed.
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Duberstein PR, Chen M, Chapman BP, Hoerger M, Saeed F, Guancial E, Mack JW. Fatalism and educational disparities in beliefs about the curability of advanced cancer. PATIENT EDUCATION AND COUNSELING 2018; 101:113-118. [PMID: 28716485 PMCID: PMC5732080 DOI: 10.1016/j.pec.2017.07.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 07/05/2017] [Accepted: 07/08/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Understanding socioeconomic disparities in the care of patients with incurable cancer is a high priority. We hypothesized that patients without a high school education are more likely to believe that they could be cured and we explored the role of fatalism. METHODS We studied 977 patients with advanced, incurable cancer. Two logistic regression analyses were conducted. Model One examined the effect of education on beliefs about curability. Model Two added fatalism. RESULTS The significant association between having less than a high school education and the belief that advanced cancer can be cured (OR=2.55; 95% CI: 1.09-5.96) in Model One was attenuated by 39% and rendered nonsignificant in Model Two. Fatalism was associated with the belief that advanced cancer can be cured. Whites were less likely to believe they could be cured than Blacks and Asians/Pacific Islanders. Beliefs about curability were not associated with income or insurance status. CONCLUSIONS People who do not complete high school are more likely to believe that their advanced cancer is curable, in part because they are more likely to hold fatalistic worldviews. PRACTICE IMPLICATIONS Interventions to help oncologists care for patients with fatalistic beliefs could mitigate socioeconomic disparities in end-of-life care.
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Affiliation(s)
- Paul R Duberstein
- Departments of Psychiatry, Medicine, and Family Medicine, University of Rochester Medical Center, 300 Crittenden Blvd., Rochester, NY, 14642, USA.
| | - Michael Chen
- Department of Public Health Sciences, University of Rochester Medical Center, 300 Crittenden Blvd., Rochester, NY, 14642, USA.
| | - Benjamin P Chapman
- Departments of Psychiatry and Public Health Sciences, University of Rochester Medical Center, 300 Crittenden Blvd., Rochester, NY, 14642, USA.
| | - Michael Hoerger
- Departments of Psychiatry, Medicine, and Psychology, Tulane University, 2007 Percival Stern Hall, New Orleans, LA, 70118, USA.
| | - Fahad Saeed
- Department of Medicine, Divisions of Nephrology and Palliative Care, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY, 14642, USA.
| | - Elizabeth Guancial
- Department of Medicine and Wilmot Cancer Institute, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY, 14642, USA.
| | - Jennifer W Mack
- Department of Pediatric Oncology and Division of Population Sciences, Dana Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA; 25 Shattuck Street, Boston, MA 02115, USA
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Abstract
Palliative care is a powerful adjunct to oncology that adds distinct value to the physical, mental, and psychosocial well-being of patients living with cancer. Its expanding role and integration with standard oncologic care has proven clinical benefit, as the practice of palliative care can help alleviate symptom burden, enhance illness and prognostic understanding, and improve both the quality of life and overall survival for patients. The primary aim of this review article is to highlight the significant interplay between palliative care and oncology and, in doing so, shed light on the areas for improvement and modern challenges that exist to meet the complex palliative care needs of patients with cancer.
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Affiliation(s)
- Rajiv Agarwal
- Department of Medicine, Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrew S Epstein
- Division of Solid Tumor Oncology, Department of Medicine, Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Palliative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, New York
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Enzinger AC, Wind JK, Frank E, McCleary NJ, Porter L, Cushing H, Abbott C, Cronin C, Enzinger PC, Meropol NJ, Schrag D. A stakeholder-driven approach to improve the informed consent process for palliative chemotherapy. PATIENT EDUCATION AND COUNSELING 2017; 100:1527-1536. [PMID: 28359659 PMCID: PMC5492511 DOI: 10.1016/j.pec.2017.03.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 03/08/2017] [Accepted: 03/17/2017] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Patients often anticipate cure from palliative chemotherapy. Better resources are needed to convey its risks and benefits. We describe the stakeholder-driven development and acceptability testing of a prototype video and companion booklet supporting informed consent (IC) for a common palliative chemotherapy regimen. METHODS Our multidisciplinary team (researchers, advocates, clinicians) employed a multistep process of content development, production, critical evaluation, and iterative revisions. Patient/clinician stakeholders were engaged throughout using stakeholder advisory panels, featuring their voices within the intervention, conducting surveys and qualitative interviews. A national panel of 57 patient advocates, and 25 oncologists from nine US practices critiqued the intervention and rated its clarity, accuracy, balance, tone, and utility. Participants also reported satisfaction with existing chemotherapy IC materials. RESULTS Few oncologists (5/25, 20%) or advocates (10/22, 45%) were satisfied with existing IC materials. In contrast, most rated our intervention highly, with 89-96% agreeing it would be useful and promote informed decisions. Patient voices were considered a key strength. Every oncologist indicated they would use the intervention regularly. CONCLUSION Our intervention was acceptable to advocates and oncologists. A randomized trial is evaluating its impact on the chemotherapy IC process. PRACTICE IMPLICATIONS Stakeholder-driven methods can be valuable for developing patient educational interventions.
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Affiliation(s)
- Andrea C Enzinger
- McGraw Patterson Center for Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA.
| | - Jennifer K Wind
- McGraw Patterson Center for Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Elizabeth Frank
- Susan F. Smith Center for Women's Cancers, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Nadine J McCleary
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Heather Cushing
- Department of Nursing, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Caroline Abbott
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
| | - Christine Cronin
- McGraw Patterson Center for Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Peter C Enzinger
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Neal J Meropol
- Division of Hematology and Oncology, University Hospitals Case Medical Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Deborah Schrag
- McGraw Patterson Center for Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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Nipp RD, Greer JA, El-Jawahri A, Moran SM, Traeger L, Jacobs JM, Jacobsen JC, Gallagher ER, Park ER, Ryan DP, Jackson VA, Pirl WF, Temel JS. Coping and Prognostic Awareness in Patients With Advanced Cancer. J Clin Oncol 2017; 35:2551-2557. [PMID: 28574777 DOI: 10.1200/jco.2016.71.3404] [Citation(s) in RCA: 158] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Patients' understanding of their illness is key for making informed treatment decisions, yet studies suggest an association between prognostic awareness and worse quality of life (QOL) and mood among patients with advanced cancer. We sought to explore the relationships among prognostic awareness, coping, QOL, and mood in patients with newly diagnosed, incurable cancer. Methods We assessed patients' self-reported health status and treatment goal (Prognosis and Treatment Perceptions Questionnaire), coping (Brief COPE), QOL (Functional Assessment of Cancer Therapy-General), and mood (Hospital Anxiety and Depression Scale) within 8 weeks of incurable lung or GI cancer diagnosis. We used linear regression to examine associations and interaction effects among patients' health status and treatment goal, coping strategies, QOL, and mood. Results Patients who reported a terminally ill health status had worse QOL (unstandardized coefficient [B] = -6.88; P < .001), depression (B = 1.60; P < .001), and anxiety (B = 1.17; P = .007). Patients who reported their oncologist's treatment goal was "to cure my cancer" had better QOL (B = 4.33; P = .03) and less anxiety (B = -1.39; P = .007). We observed interaction effects between self-reported health status and treatment goal and certain coping strategies. Specifically, subgroup analyses showed that greater use of positive reframing was related to better QOL (B = 2.61; P < .001) and less depression (B = -0.78; P < .001) among patients who reported a terminally ill health status. Active coping was associated with better QOL (B = 3.50; P < .001) and less depression (B = -1.01; P < .001) among patients who acknowledged their oncologist's treatment goal was not "to cure my cancer." Conclusion Prognostic awareness is related to worse QOL and mood in patients with newly diagnosed, incurable cancer; however, the use of certain coping strategies may buffer these relationships. Interventions to improve patients' prognostic awareness should seek to cultivate more adaptive coping strategies in order to enhance QOL and mood.
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Affiliation(s)
- Ryan D Nipp
- All authors: Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Joseph A Greer
- All authors: Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Areej El-Jawahri
- All authors: Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Samantha M Moran
- All authors: Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Lara Traeger
- All authors: Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Jamie M Jacobs
- All authors: Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Juliet C Jacobsen
- All authors: Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Emily R Gallagher
- All authors: Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Elyse R Park
- All authors: Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - David P Ryan
- All authors: Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Vicki A Jackson
- All authors: Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - William F Pirl
- All authors: Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Jennifer S Temel
- All authors: Harvard Medical School, Massachusetts General Hospital, Boston, MA
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Hoerger M, Perry LM, Gramling R, Epstein RM, Duberstein PR. Does educating patients about the Early Palliative Care Study increase preferences for outpatient palliative cancer care? Findings from Project EMPOWER. Health Psychol 2017; 36:538-548. [PMID: 28277698 PMCID: PMC5444973 DOI: 10.1037/hea0000489] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Randomized controlled trials, especially the Early Palliative Care Study (Temel et al., 2010), have shown that early outpatient palliative cancer care can improve quality of life for patients with advanced cancer or serious symptoms. However, fear and misconceptions drive avoidance of palliative care. Drawing from an empowerment perspective, we examined whether educating patients about evidence from the Early Palliative Care Study would increase preferences for palliative care. METHOD A sample of 598 patients with prostate, breast, lung, colon/rectal, skin, and other cancer diagnoses completed an Internet-mediated experiment using a between-group prepost design. Intervention participants received a summary of the Early Palliative Care Study; controls received no intervention. Participants completed baseline and posttest assessments of preferences of palliative care. Analyses controlled for age, gender, education, cancer type, presence of metastases, time since diagnosis, and baseline preferences. RESULTS As hypothesized, the intervention had a favorable impact on participants' preferences for outpatient palliative cancer care relative to controls (d = 1.01, p < .001), while controlling for covariates. Intervention participants came to view palliative care as more efficacious (d = 0.79, p < .001) and less scary (d = 0.60, p < .001) and exhibited stronger behavioral intentions to utilize outpatient palliative care if referred (d = 0.60, p < .001). Findings were comparable in patients with metastatic disease, those with less education, and those experiencing financial strain. CONCLUSIONS Educating patients about the Early Palliative Care Study increases preferences for early outpatient palliative care. This research has implications for future studies aimed at improving quality of life in cancer by increasing palliative care utilization. (PsycINFO Database Record
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Agarwal R, Epstein AS. Palliative care and advance care planning for pancreas and other cancers. Chin Clin Oncol 2017; 6:32. [PMID: 28705009 PMCID: PMC6119222 DOI: 10.21037/cco.2017.06.16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 05/27/2017] [Indexed: 12/25/2022]
Abstract
The principles of palliative care are fundamental to support and treat the physical, mental, and psychosocial health of patients living with pancreatic cancer. In addition to its proven advantages to help manage disease-related symptoms, improve accurate illness understanding, and enhance the quality of life and survival outcomes for patients with advanced disease, the inclusion of palliative care principles (whether by a specialist or by the primary oncology team) with standard oncologic care strengthens timely and quality advance care planning (ACP). The primary objective of this review article is to underscore the significant value of palliative care integration and ACP in oncology, including but not limited to care at the end of life, with a particular focus on its relevance to patients with advanced pancreatic cancer.
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Affiliation(s)
- Rajiv Agarwal
- Department of Medicine, Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Andrew S Epstein
- Gastrointestinal Oncology Service, Palliative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, USA.
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How good are we at predicting the fate of someone with acute myeloid leukaemia? Leukemia 2017; 31:1255-1258. [PMID: 28303892 DOI: 10.1038/leu.2017.56] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Smith SR, Zheng JY. The Intersection of Oncology Prognosis and Cancer Rehabilitation. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2017; 5:46-54. [PMID: 28458958 PMCID: PMC5387014 DOI: 10.1007/s40141-017-0150-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW This review examines the delivery of rehabilitation care to cancer patients with relation to disease prognosis. This includes the evaluation when patients are referred for rehabilitation services and the effectiveness of rehabilitation interventions across the cancer continuum. RECENT FINDINGS Although prognosticating life expectancy is difficult, referrals for rehabilitation interventions appear to be affected by physician attitudes towards patients with advanced disease, in part because of misconceptions about the nature of rehabilitation for oncology patients. Rehabilitation may also be underutilized in long-term survivors with no evidence of disease. Despite this, our review found that rehabilitation in advanced disease, end-of-life, geriatric cancer patients, and in long-term survivors can be beneficial. There is a relative dearth in studies on rehabilitation interventions specifically at the end-of-life. SUMMARY Cancer rehabilitation can be helpful to patients along the spectrum of cancer prognoses. Examining more accurate ways to prognosticate life expectancy, improving communication and education between oncologists and rehabilitation team members, and modifying survivorship plans to include patient education on functional changes over time may improve the delivery of rehabilitation care.
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Affiliation(s)
- Sean Robinson Smith
- Department of Physical Medicine & Rehabilitation, University of Michigan, 325 E Eisenhower Pkwy, Ste 100, Ann Arbor, MI 48108 USA
| | - Jasmine Yiqian Zheng
- Department of Physical Medicine & Rehabilitation, University of Michigan, 325 E Eisenhower Pkwy, Ste 100, Ann Arbor, MI 48108 USA
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Dulaney C, Wallace AS, Everett AS, Dover L, McDonald A, Kropp L. Defining Health Across the Cancer Continuum. Cureus 2017; 9:e1029. [PMID: 28357161 PMCID: PMC5354402 DOI: 10.7759/cureus.1029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Health is not defined by the absence of disease or suffering, but by response to a series of life events that can markedly alter the quality and quantity of life. Patients with cancer experience significant but dynamic physical, psychosocial, and financial challenges. With the increasing number of patients with early stage cancers transitioning to survivorship, there is a critical need to address health promotion and overall well-being. For those with advanced cancer, discussion about prognosis and early integration of palliative care can have a profound impact on the quality of life. Effective communication between healthcare providers and patients is important in aligning treatment recommendations with patient goals and preferences throughout cancer therapy. This review provides a dynamic definition of health and proposes actionable guidelines for health promotion at any point along the cancer continuum: survivorship after early cancer or when goals of care transition to improve quality at the end of life.
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Affiliation(s)
- Caleb Dulaney
- Department of Radiation Oncology, University of Alabama at Birmingham
| | - Audrey S Wallace
- Department of Radiation Oncology, University of Alabama at Birmingham
| | - Ashlyn S Everett
- Department of Radiation Oncology, University of Alabama at Birmingham
| | - Laura Dover
- Department of Radiation Oncology, University of Alabama at Birmingham
| | - Andrew McDonald
- Department of Radiation Oncology, University of Alabama at Birmingham
| | - Lauren Kropp
- Department of Radiation Oncology, University of Alabama at Birmingham
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Rodenbach RA, Brandes K, Fiscella K, Kravitz RL, Butow PN, Walczak A, Duberstein PR, Sullivan P, Hoh B, Xing G, Plumb S, Epstein RM. Promoting End-of-Life Discussions in Advanced Cancer: Effects of Patient Coaching and Question Prompt Lists. J Clin Oncol 2017; 35:842-851. [PMID: 28135140 DOI: 10.1200/jco.2016.68.5651] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To build on results of a cluster randomized controlled trial (RCT) of a combined patient-oncologist intervention to improve communication in advanced cancer, we conducted a post hoc analysis of the patient intervention component, a previsit patient coaching session that used a question prompt list (QPL). We hypothesized that intervention-group participants would bring up more QPL-related topics, particularly prognosis-related topics, during the subsequent oncologist visit. Patients and Methods This cluster RCT with 170 patients who had advanced nonhematologic cancer (and their caregivers) recruited from practices of 24 participating oncologists in western New York. Intervention-group oncologists (n = 12) received individualized communication training; up to 10 of their patients (n = 84) received a previsit individualized communication coaching session that incorporated a QPL. Control-group oncologists (n = 12) and patients (n = 86) received no interventions. Topics of interest identified by patients during the coaching session were summarized from coaching notes; one office visit after the coaching session was audio recorded, transcribed, and analyzed by using linear regression modeling for group differences. Results Compared with controls, more than twice as many intervention-group participants brought up QPL-related topics during their office visits (70.2% v 32.6%; P < .001). Patients in the intervention group were nearly three times more likely to ask about prognosis (16.7% v 5.8%; P =.03). Of 262 topics of interest identified during coaching, 158 (60.3%) were QPL related; 20 (12.7%) addressed prognosis. Overall, patients in the intervention group brought up 82.4% of topics of interest during the office visit. Conclusion A combined coaching and QPL intervention was effective to help patients with advanced cancer and their caregivers identify and bring up topics of concern, including prognosis, during their subsequent oncologist visits. Considering that most patients are misinformed about prognosis, more intensive steps are needed to better promote such discussions.
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Affiliation(s)
- Rachel A Rodenbach
- Rachel A. Rodenbach, Kevin Fiscella, Paul R. Duberstein, Peter Sullivan, Beth Hoh, Sandy Plumb, and Ronald M. Epstein, Center for Communication and Disparities Research; Rachel A. Rodenbach and Ronald M. Epstein, University of Rochester School of Medicine and Dentistry; Kevin Fiscella and Paul R. Duberstein, University of Rochester Medical Center, Rochester, NY; Rachel A. Rodenbach, University of Pittsburgh Medical Center, Pittsburgh, PA; Kim Brandes, University of Amsterdam, Amsterdam, the Netherlands; Richard L. Kravitz and Guibo Xing, University of California Davis, Sacramento, CA; and Phyllis N. Butow and Adam Walczak, The University of Sydney, Sydney, New South Wales, Australia
| | - Kim Brandes
- Rachel A. Rodenbach, Kevin Fiscella, Paul R. Duberstein, Peter Sullivan, Beth Hoh, Sandy Plumb, and Ronald M. Epstein, Center for Communication and Disparities Research; Rachel A. Rodenbach and Ronald M. Epstein, University of Rochester School of Medicine and Dentistry; Kevin Fiscella and Paul R. Duberstein, University of Rochester Medical Center, Rochester, NY; Rachel A. Rodenbach, University of Pittsburgh Medical Center, Pittsburgh, PA; Kim Brandes, University of Amsterdam, Amsterdam, the Netherlands; Richard L. Kravitz and Guibo Xing, University of California Davis, Sacramento, CA; and Phyllis N. Butow and Adam Walczak, The University of Sydney, Sydney, New South Wales, Australia
| | - Kevin Fiscella
- Rachel A. Rodenbach, Kevin Fiscella, Paul R. Duberstein, Peter Sullivan, Beth Hoh, Sandy Plumb, and Ronald M. Epstein, Center for Communication and Disparities Research; Rachel A. Rodenbach and Ronald M. Epstein, University of Rochester School of Medicine and Dentistry; Kevin Fiscella and Paul R. Duberstein, University of Rochester Medical Center, Rochester, NY; Rachel A. Rodenbach, University of Pittsburgh Medical Center, Pittsburgh, PA; Kim Brandes, University of Amsterdam, Amsterdam, the Netherlands; Richard L. Kravitz and Guibo Xing, University of California Davis, Sacramento, CA; and Phyllis N. Butow and Adam Walczak, The University of Sydney, Sydney, New South Wales, Australia
| | - Richard L Kravitz
- Rachel A. Rodenbach, Kevin Fiscella, Paul R. Duberstein, Peter Sullivan, Beth Hoh, Sandy Plumb, and Ronald M. Epstein, Center for Communication and Disparities Research; Rachel A. Rodenbach and Ronald M. Epstein, University of Rochester School of Medicine and Dentistry; Kevin Fiscella and Paul R. Duberstein, University of Rochester Medical Center, Rochester, NY; Rachel A. Rodenbach, University of Pittsburgh Medical Center, Pittsburgh, PA; Kim Brandes, University of Amsterdam, Amsterdam, the Netherlands; Richard L. Kravitz and Guibo Xing, University of California Davis, Sacramento, CA; and Phyllis N. Butow and Adam Walczak, The University of Sydney, Sydney, New South Wales, Australia
| | - Phyllis N Butow
- Rachel A. Rodenbach, Kevin Fiscella, Paul R. Duberstein, Peter Sullivan, Beth Hoh, Sandy Plumb, and Ronald M. Epstein, Center for Communication and Disparities Research; Rachel A. Rodenbach and Ronald M. Epstein, University of Rochester School of Medicine and Dentistry; Kevin Fiscella and Paul R. Duberstein, University of Rochester Medical Center, Rochester, NY; Rachel A. Rodenbach, University of Pittsburgh Medical Center, Pittsburgh, PA; Kim Brandes, University of Amsterdam, Amsterdam, the Netherlands; Richard L. Kravitz and Guibo Xing, University of California Davis, Sacramento, CA; and Phyllis N. Butow and Adam Walczak, The University of Sydney, Sydney, New South Wales, Australia
| | - Adam Walczak
- Rachel A. Rodenbach, Kevin Fiscella, Paul R. Duberstein, Peter Sullivan, Beth Hoh, Sandy Plumb, and Ronald M. Epstein, Center for Communication and Disparities Research; Rachel A. Rodenbach and Ronald M. Epstein, University of Rochester School of Medicine and Dentistry; Kevin Fiscella and Paul R. Duberstein, University of Rochester Medical Center, Rochester, NY; Rachel A. Rodenbach, University of Pittsburgh Medical Center, Pittsburgh, PA; Kim Brandes, University of Amsterdam, Amsterdam, the Netherlands; Richard L. Kravitz and Guibo Xing, University of California Davis, Sacramento, CA; and Phyllis N. Butow and Adam Walczak, The University of Sydney, Sydney, New South Wales, Australia
| | - Paul R Duberstein
- Rachel A. Rodenbach, Kevin Fiscella, Paul R. Duberstein, Peter Sullivan, Beth Hoh, Sandy Plumb, and Ronald M. Epstein, Center for Communication and Disparities Research; Rachel A. Rodenbach and Ronald M. Epstein, University of Rochester School of Medicine and Dentistry; Kevin Fiscella and Paul R. Duberstein, University of Rochester Medical Center, Rochester, NY; Rachel A. Rodenbach, University of Pittsburgh Medical Center, Pittsburgh, PA; Kim Brandes, University of Amsterdam, Amsterdam, the Netherlands; Richard L. Kravitz and Guibo Xing, University of California Davis, Sacramento, CA; and Phyllis N. Butow and Adam Walczak, The University of Sydney, Sydney, New South Wales, Australia
| | - Peter Sullivan
- Rachel A. Rodenbach, Kevin Fiscella, Paul R. Duberstein, Peter Sullivan, Beth Hoh, Sandy Plumb, and Ronald M. Epstein, Center for Communication and Disparities Research; Rachel A. Rodenbach and Ronald M. Epstein, University of Rochester School of Medicine and Dentistry; Kevin Fiscella and Paul R. Duberstein, University of Rochester Medical Center, Rochester, NY; Rachel A. Rodenbach, University of Pittsburgh Medical Center, Pittsburgh, PA; Kim Brandes, University of Amsterdam, Amsterdam, the Netherlands; Richard L. Kravitz and Guibo Xing, University of California Davis, Sacramento, CA; and Phyllis N. Butow and Adam Walczak, The University of Sydney, Sydney, New South Wales, Australia
| | - Beth Hoh
- Rachel A. Rodenbach, Kevin Fiscella, Paul R. Duberstein, Peter Sullivan, Beth Hoh, Sandy Plumb, and Ronald M. Epstein, Center for Communication and Disparities Research; Rachel A. Rodenbach and Ronald M. Epstein, University of Rochester School of Medicine and Dentistry; Kevin Fiscella and Paul R. Duberstein, University of Rochester Medical Center, Rochester, NY; Rachel A. Rodenbach, University of Pittsburgh Medical Center, Pittsburgh, PA; Kim Brandes, University of Amsterdam, Amsterdam, the Netherlands; Richard L. Kravitz and Guibo Xing, University of California Davis, Sacramento, CA; and Phyllis N. Butow and Adam Walczak, The University of Sydney, Sydney, New South Wales, Australia
| | - Guibo Xing
- Rachel A. Rodenbach, Kevin Fiscella, Paul R. Duberstein, Peter Sullivan, Beth Hoh, Sandy Plumb, and Ronald M. Epstein, Center for Communication and Disparities Research; Rachel A. Rodenbach and Ronald M. Epstein, University of Rochester School of Medicine and Dentistry; Kevin Fiscella and Paul R. Duberstein, University of Rochester Medical Center, Rochester, NY; Rachel A. Rodenbach, University of Pittsburgh Medical Center, Pittsburgh, PA; Kim Brandes, University of Amsterdam, Amsterdam, the Netherlands; Richard L. Kravitz and Guibo Xing, University of California Davis, Sacramento, CA; and Phyllis N. Butow and Adam Walczak, The University of Sydney, Sydney, New South Wales, Australia
| | - Sandy Plumb
- Rachel A. Rodenbach, Kevin Fiscella, Paul R. Duberstein, Peter Sullivan, Beth Hoh, Sandy Plumb, and Ronald M. Epstein, Center for Communication and Disparities Research; Rachel A. Rodenbach and Ronald M. Epstein, University of Rochester School of Medicine and Dentistry; Kevin Fiscella and Paul R. Duberstein, University of Rochester Medical Center, Rochester, NY; Rachel A. Rodenbach, University of Pittsburgh Medical Center, Pittsburgh, PA; Kim Brandes, University of Amsterdam, Amsterdam, the Netherlands; Richard L. Kravitz and Guibo Xing, University of California Davis, Sacramento, CA; and Phyllis N. Butow and Adam Walczak, The University of Sydney, Sydney, New South Wales, Australia
| | - Ronald M Epstein
- Rachel A. Rodenbach, Kevin Fiscella, Paul R. Duberstein, Peter Sullivan, Beth Hoh, Sandy Plumb, and Ronald M. Epstein, Center for Communication and Disparities Research; Rachel A. Rodenbach and Ronald M. Epstein, University of Rochester School of Medicine and Dentistry; Kevin Fiscella and Paul R. Duberstein, University of Rochester Medical Center, Rochester, NY; Rachel A. Rodenbach, University of Pittsburgh Medical Center, Pittsburgh, PA; Kim Brandes, University of Amsterdam, Amsterdam, the Netherlands; Richard L. Kravitz and Guibo Xing, University of California Davis, Sacramento, CA; and Phyllis N. Butow and Adam Walczak, The University of Sydney, Sydney, New South Wales, Australia
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Epstein RM, Duberstein PR, Fenton JJ, Fiscella K, Hoerger M, Tancredi DJ, Xing G, Gramling R, Mohile S, Franks P, Kaesberg P, Plumb S, Cipri CS, Street RL, Shields CG, Back AL, Butow P, Walczak A, Tattersall M, Venuti A, Sullivan P, Robinson M, Hoh B, Lewis L, Kravitz RL. Effect of a Patient-Centered Communication Intervention on Oncologist-Patient Communication, Quality of Life, and Health Care Utilization in Advanced Cancer: The VOICE Randomized Clinical Trial. JAMA Oncol 2017; 3:92-100. [PMID: 27612178 PMCID: PMC5832439 DOI: 10.1001/jamaoncol.2016.4373] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE 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. OBJECTIVE 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. INTERVENTIONS 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. RESULTS 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. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01485627.
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Affiliation(s)
- Ronald M Epstein
- Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, New York2Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York3Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York4James P Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Paul R Duberstein
- Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, New York2Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York3Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Joshua J Fenton
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento6UC Davis Comprehensive Cancer Center, University of California, Davis, Sacramento7Department of Family and Community Medicine, University of California, Davis, Sacramento
| | - Kevin Fiscella
- Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, New York2Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York8Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York9Center for Community Health, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Michael Hoerger
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York10Departments of Psychology, Psychiatry, and Medicine, Tulane University, New Orleans, Louisiana11Tulane Cancer Center, Tulane University, New Orleans, Louisiana
| | - Daniel J Tancredi
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento12Department of Pediatrics, University of California, Davis, Sacramento
| | - Guibo Xing
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento
| | - Robert Gramling
- Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, New York2Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York8Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York13School of Nursing, University of Rochester, Rochester, New York14Division of Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Supriya Mohile
- James P Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, New York15Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Peter Franks
- Department of Family and Community Medicine, University of California, Davis, Sacramento
| | - Paul Kaesberg
- UC Davis Comprehensive Cancer Center, University of California, Davis, Sacramento16Department of Internal Medicine, University of California, Davis, Sacramento
| | - Sandy Plumb
- Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Camille S Cipri
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento
| | - Richard L Street
- Department of Communication, Texas A & M University, College Station18Houston Center for Healthcare Innovation, Quality, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas19Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Cleveland G Shields
- Human Development and Family Studies Department, Purdue University, West Lafayette, Indiana21Purdue University Center for Cancer Research, Purdue University, West Lafayette, Indiana22Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, Indiana23Center on Poverty and Health Inequities, Purdue University, West Lafayette, Indiana24College of Health of Human Sciences, Purdue University, West Lafayette, Indiana
| | - Anthony L Back
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle26Cambia Palliative Care Center of Excellence, University of Washington, Seattle
| | - Phyllis Butow
- Centre for Medical Psychology and Evidence-based Decision-making, University of Sydney, Sydney, Australia28Psycho-oncology Co-operative Research Group, University of Sydney, Sydney, Australia
| | - Adam Walczak
- Centre for Medical Psychology and Evidence-based Decision-making, University of Sydney, Sydney, Australia29School of Psychology, University of Sydney, Sydney, Australia
| | - Martin Tattersall
- Centre for Medical Psychology and Evidence-based Decision-making, University of Sydney, Sydney, Australia30Sydney Medical School, University of Sydney, Sydney, Australia31Royal Prince Alfred Hospital, Sydney, Australia
| | - Alison Venuti
- Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Peter Sullivan
- Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Mark Robinson
- University of California, Davis School of Medicine, University of California, Davis, Sacramento
| | - Beth Hoh
- Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, New York2Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York34Department of Social Work, Strong Memorial Hospital, Rochester, New York
| | - Linda Lewis
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento
| | - Richard L Kravitz
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento6UC Davis Comprehensive Cancer Center, University of California, Davis, Sacramento35Division of General Medicine, University of California, Davis, Sacramento
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