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Dickerson LK, Lipson TA, Chauhan SSB, Allen GI, Young B, Park JO, Pillarisetty VG, O'Connell KM, Sham JG. Evaluating surgeon communication of pancreatic cancer prognosis using the VitalTalk ADAPT framework. J Surg Oncol 2024. [PMID: 38990255 DOI: 10.1002/jso.27777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/24/2024] [Accepted: 07/01/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND AND OBJECTIVES Few data exist to guide optimal communication practices for surgical oncologists. VitalTalk, an evidence-based communication skills training model for clinicians, offers the five-step ADAPT tool for discussing prognosis. This study aimed to characterize surgeon communication of pancreatic cancer prognosis using VitalTalk's ADAPT framework. METHODS Contemporaneous audio recordings from 12 initial surgeon-patient encounters for borderline resectable pancreatic cancer were transcribed. Directed qualitative content analysis based on ADAPT (Ask, Discover, Anticipate, Provide, and Track) was used to deductively code transcripts. RESULTS All encounters contained at least one ADAPT step while only one (8%) incorporated four or five steps. Surgeons provided prognostic information (Provide) in all but one encounter (92%); most was qualitative and clustered into themes: serious illness, surgical candidacy, prognostic ambiguity, and cancer recurrence. Surgeons elicited understanding (Ask), requested information preferences (Discover), anticipated ambivalence (Anticipate), and responded to emotion (Track) in a minority of encounters (25%-42%); of 15 patient emotional cues, six were not addressed by surgeons. CONCLUSIONS During an initial encounter for pancreatic cancer, surgeons focus heavily on providing information but omit critical prognostic communication steps. Future studies are needed to investigate if surgeon training in palliative care-based communication is feasible and impacts patient-perceived quality of communication.
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Affiliation(s)
- Lindsay K Dickerson
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Trisha A Lipson
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | | | - Griffen I Allen
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Bill Young
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - James O Park
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Venu G Pillarisetty
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Kathleen M O'Connell
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jonathan G Sham
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
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Cheng BBY, Ryan BJ, Copland DA, Wallace SJ. Prognostication in post-stroke aphasia: Perspectives of people with aphasia on receiving information about recovery. Neuropsychol Rehabil 2022; 33:871-902. [PMID: 35297737 DOI: 10.1080/09602011.2022.2051565] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Many people with aphasia (language impairment post-stroke) want to know their prognosis for recovery, yet current understanding of their experience of receiving prognoses is limited. Such insight is necessary to inform clinical practice in formulating and delivering aphasia prognoses, especially given the psycho-emotional distress and secondary adverse effects on recovery associated with conversations about prognosis. We sought an in-depth understanding of the perspectives of people with aphasia in relation to receiving prognoses post-stroke, with the aim of informing an evidence-based approach to aphasia prognostication in clinical practice. Semi-structured interviews, facilitated by communication support strategies, were conducted one-to-one with eight people with aphasia (ranging from mild to very severe) 3-12 months post-stroke. Reflexive thematic analysis was used to analyse the qualitative data, yielding two over-arching themes: (1) How would you know without knowing me?; (2) I need to know, but I don't want to know. Our findings illustrate issues of mistrust within the patient-clinician relationship, and complex emotions relating to hope and post-stroke adjustment. The present insight into the lived experience of receiving aphasia prognoses highlights the need for focused consideration of personal definitions of normalcy, measures for fostering trust, and the role of prognostic uncertainty.
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Affiliation(s)
- Bonnie B Y Cheng
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.,Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia
| | - Brooke J Ryan
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.,Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia.,NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Brisbane, Australia.,Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, Australia
| | - David A Copland
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.,Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia.,NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Brisbane, Australia
| | - Sarah J Wallace
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.,Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia.,NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Brisbane, Australia
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Brédart A, Rault A, Terrasson J, Seigneur E, De Koning L, Hess E, Savignoni A, Cottu P, Pierga JY, Piperno-Neumann S, Rodrigues M, Bouleuc C, Dolbeault S. Helping Patients Communicate With Oncologists When Cancer Treatment Resistance Occurs to Develop, Test, and Implement a Patient Communication Aid: Sequential Collaborative Mixed Methods Study. JMIR Res Protoc 2022; 11:e26414. [PMID: 35019850 PMCID: PMC8792782 DOI: 10.2196/26414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 11/16/2021] [Accepted: 11/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Most cancer-related deaths result from disseminated diseases that develop resistance to anticancer treatments. Inappropriate communication in this challenging situation may result in unmet patient information and support needs. Patient communication aids such as question prompt lists (QPLs) may help. OBJECTIVE This study aims to develop and pilot-test a specific QPL in the following two contrasting clinical contexts in France after cancer resistance has developed: triple-negative and luminal B metastatic breast cancer (MBC) and metastatic uveal melanoma (MUM). METHODS A sequential study design with a mixed methods collaborative approach will be applied. The first step aims to build a specific QPL. Step 1a will explore oncologist-patient communication issues from oncology professionals' interviews (n=20 approximately). Step 1b will appraise information and support needs experienced by patients with MBC or MUM both quantitatively (n=80) and qualitatively (n=40 approximately). These data will be used to develop and pilot-test a QPL specific to patients with cancer experiencing initial or acquired resistance to treatment. We expect to obtain a core QPL that comprises questions and concerns commonly expressed by patients with resistant cancer and is complemented by specific issues for either MBC or MUM cancer sites. In step 1c, 2 focus groups of patients with any type of metastatic cancer (n=4) and health care professionals (n=4) will be conducted to revise the content of a preliminary QPL and elaborate an acceptable and feasible clinical implementation. In step 1d, the content of the QPL version 1 and implementation guidance will be validated using a Delphi process. Step 2 will pilot-test the QPL version 1 in real practice with patients with MBC or MUM (n=80). Clinical utility will be assessed by comparing responses to questionnaires administered in step 1b (QPL-naive historical control group) and step 2 (QPL intervention group). RESULTS This study received grants in March and December 2019 and was approved by the French national ethics committee in July 2019. As of October 2021, interviews with oncology professionals have been conducted and analyzed (N=26 to reach saturation), and 39 and 27 patients with MBC and MUM, respectively, have been recruited. CONCLUSIONS A clinically and culturally tailored QPL is expected to facilitate patients' participation in consultations, improve oncologists' responses to patients' information and support needs, and thus foster patients' psychological adjustment to the diagnosis and follow-up of cancer resistance to treatment. TRIAL REGISTRATION ClinicalTrials.gov NCT04118062; http://clinicaltrials.gov/ct2/show/NCT04118062. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/26414.
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Affiliation(s)
- Anne Brédart
- Psycho-Oncology Unit, Institut Curie, Paris Sciences et Lettres Research University, Paris, France
- Psychopathology and Health Process, Paris University, Boulogne Billancourt, France
| | - Aude Rault
- Psycho-Oncology Unit, Institut Curie, Paris Sciences et Lettres Research University, Paris, France
| | - Johanna Terrasson
- Psycho-Oncology Unit, Institut Curie, Paris Sciences et Lettres Research University, Paris, France
| | - Etienne Seigneur
- Psycho-Oncology Unit, Institut Curie, Paris Sciences et Lettres Research University, Paris, France
| | - Leanne De Koning
- Research Centre, Paris Sciences et Lettres Research University, Institut Curie, Paris, France
| | - Elisabeth Hess
- Research Centre, Paris Sciences et Lettres Research University, Institut Curie, Paris, France
| | - Alexia Savignoni
- Direction Recherche Ensemble Hospitalier, Data Management Unit, Biometry Department, Institut Curie, Saint-Cloud, France
| | - Paul Cottu
- Medical Oncology Department, Institut Curie, Paris, France
| | - Jean-Yves Pierga
- Medical Oncology Department, Institut Curie, Paris, France
- Faculty of medicine, Paris University, Paris, France
| | | | | | - Carole Bouleuc
- Département Interdisciplinaire de Soins de Support pour le Patient en Oncologie, Department of Supportive Care, Institut Curie, Paris, France
| | - Sylvie Dolbeault
- Psycho-Oncology Unit, Institut Curie, Paris Sciences et Lettres Research University, Paris, France
- Research Centre in Epidemiology and Population Health (CESP), INSERM, U1018, University Paris-Sud, Villejuif, France
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Dale MacLaine T, Lowe N, Dale J. The use of simulation in medical student education on the topic of breaking bad news: A systematic review. PATIENT EDUCATION AND COUNSELING 2021; 104:2670-2681. [PMID: 33926808 DOI: 10.1016/j.pec.2021.04.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Simulated patients (SPs) are widely used, but the most effective way of utilising them in undergraduate breaking bad news (BBN) medical education is unknown. OBJECTIVES To conduct a systematic review into SP's use in developing BBN skills in medical students. METHODS 14 databases searched with the terms "Medical education", "Patient simulation", "Bad news". Data was systematically extracted, and thematic analysis undertaken. RESULTS Of 2117 articles screened, 29 publications met the inclusion criteria. These demonstrated a variety of SP models, including actors as patients (65.5%), peers (7.0%), and cancer survivors (3.5%). with delivery at varying times in the curricula. SPs are uniformly reported as having positive impact, but there is a lack of high-quality evidence comparing the use of differing forms of training. There was some evidence that virtual SPs were as useful as in-person SPs. CONCLUSIONS SPs allow students to practise vital BBN communication skills without risking detriment to patient care. Despite the heterogeneity of ways in which SPs have been used, the benefits of different approaches and when and how these should be delivered remains unclear. PRACTICE IMPLICATIONS Further educational development and research is needed about the use of SPs to support undergraduate BBN communication skills development.
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Affiliation(s)
| | - Nicholas Lowe
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, UK.
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Cheng BBY, Ryan B, Copland DA, Wallace SJ. Prognostication in post-stroke aphasia: speech pathologists' clinical insights on formulating and delivering information about recovery. Disabil Rehabil 2021; 44:5046-5059. [PMID: 33969776 DOI: 10.1080/09638288.2021.1922514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE For people with post-stroke aphasia, "Will I get better?" is a question often asked, but one that is intellectually and emotionally demanding for speech pathologists to answer. Speech pathologists' formulation and delivery of aphasia prognoses is varied and there is limited evidence for optimising practice. We aimed to understand speech pathologists' clinical experiences, reasoning, and support needs in aphasia prognostication. MATERIALS AND METHODS Twenty-five Australian speech pathologists working with people with aphasia participated in individual, semi-structured interviews. Their age, level of experience, work setting, and location were maximally varied. Interview responses were analysed qualitatively using thematic analysis. RESULTS Five themes were drawn from the interviews: (1) prognostic challenges are shared but not voiced; (2) truth is there's no quick fix; (3) recovery is more than words; (4) the power of words; and, (5) prognostic competence is implicit. CONCLUSIONS Speech pathologists use implicit competencies to formulate and deliver aphasia prognoses. A patient-centred, holistic contextualisation of aphasia recovery may enable realistic, optimistic, and constructive conversations about prognosis. These conversations may have therapeutic potential if prognostic uncertainty, emotional adjustment, and conditional outcomes are carefully addressed. Future research should seek to understand the perceptions and preferences of people with aphasia and their significant others.Implications for RehabilitationAphasia prognostication in clinical practice is complex and nuanced, thus increased clinical and research focus is warranted to ensure key stakeholder needs are met.Conversations about prognosis may be more meaningful to people with aphasia if recovery is conceptualised as encompassing impairment, activity, and participation outcomes.Given the implicit competencies required for prognostication, a structured approach to reflective practice and experience-based training may be beneficial.Conversations about prognosis may have therapeutic value, but further research is needed to explore this potential.
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Affiliation(s)
- Bonnie B Y Cheng
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.,Queensland Aphasia Research Centre, Herston, Australia.,NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia
| | - Brooke Ryan
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.,Queensland Aphasia Research Centre, Herston, Australia.,NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia.,Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, Australia
| | - David A Copland
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.,Queensland Aphasia Research Centre, Herston, Australia.,NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia.,University of Queensland Centre for Clinical Research, Herston, Australia
| | - Sarah J Wallace
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.,Queensland Aphasia Research Centre, Herston, Australia.,NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia
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