Preconsultation compassion intervention to reduce anxiety among patients referred to a cancer center: protocol for a randomised control trial

The effect of clinician-expressed empathy and nocebo-alleviating information on breast-cancer-patients' anxiety and side effects during active chemotherapy: A clinical feasibility study

Objective

We set up a pilot-study to investigate main and interaction effects of nocebo-alleviating information and clinician-expressed empathy delivered via a standardized information-video on breast cancer patients' psychological and side effect outcomes during chemotherapy. Additionally, we aimed to reflect on the feasibility of the intervention (acceptability, practicality and integration) to inform future - follow-up - studies.

Methods

Using a clinical proof-of-principle randomized controlled trial, female breast cancer patients undergoing chemotherapy viewed one of four videos, varying in the level of nocebo-alleviating information(+/-) and clinician-expressed empathy(+/-). Due to the small sample size (n = 27), descriptive and recruitment data were utilized to evaluate effects and reflect on feasibility.

Results

The interventions appeared to yield limited effects on our small sample. Feasibility reflections mainly focused on the practical level, such as the use of more generalizable videos and optimizing the flow.

Conclusion

The study showed limited effects of the video intervention. It revealed recruitment challenges, while acceptability was high after inclusion. Moving forward, face-to-face clinician-patient interactions remain important, while cautiously exploring the potential benefits of modern technological advancements, ensuring thorough testing of their effects before implementation.

Innovation

This study marks an innovative approach in utilizing digital interventions to enhance cancer patient outcomes within clinical settings.

Preconsultation compassion video to reduce anxiety among patients referred to a cancer centre: a randomised control trial

Objective

Anxiety is common among patients attending an initial oncology consultation. The objective of this trial was to test if an enhanced compassion video emailed to patients prior to their initial oncology consultation reduces anxiety compared with being sent an information-only introduction video.

Methods and analysis

We conducted a randomised control trial at a single university-based cancer centre between May 2021 and October 2023. We enrolled adult patients scheduled for an initial cancer consultation. Subjects underwent simple 1:1 randomisation to receive either a standard introduction video or an enhanced compassion video via email. Investigators and subjects were blinded to allocation. The primary outcome was degree of anxiety on arrival to the initial oncology consultation, measured using the Hospital Anxiety and Depression scale (HADS).

Results

Of 1005 subjects randomised to the standard video and 1038 to the enhanced compassion video, 183 and 179 subjects completed the HADS-anxiety in each group, respectively. Only 25% reported watching their assigned video. There was no difference in degree of anxiety between the standard or compassion video groups using intention to treat analysis (median (IQR) 7 (4-10) vs 7 (4-10), p value=0.473)) or per-protocol analysis (limited to subjects who reported watching the video) (median (IQR) 7 (4-10) (n=45) vs 7 (5-10) (n=46), p value=0.997).

Conclusion

Receiving an enhanced compassion video did not reduce anxiety compared with a standard introduction video. Given 25% of subjects reported watching their assigned video, future research should focus on identifying interventions at the point-of-care to reduce anxiety.

Trial registration number

NCT04503681.