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Butow P, Brown R, Aldridge J, Juraskova I, Zoller P, Boyle F, Wilson M, Bernhard J. Can consultation skills training change doctors' behaviour to increase involvement of patients in making decisions about standard treatment and clinical trials: a randomized controlled trial. Health Expect 2014; 18:2570-83. [PMID: 24975503 DOI: 10.1111/hex.12229] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Informed consent is required for both standard cancer treatments and experimental cancer treatments in a clinical trial. Effective and sensitive physician-patient communication about informed consent is difficult to achieve. Our aim was to train doctors in clear, collaborative and ethical communication about informed consent and evaluate the impact of training on doctor behaviour, stress and satisfaction. PARTICIPANTS AND METHODS Participants were 21 oncologists from 10 Australian/New Zealand (ANZ) centres and 41 oncologists from 10 Swiss/German/Austrian (SGA) centres. Oncologists were randomized to participate in a 1-day workshop or not. Patients were recruited before and after the training. Doctors were asked to submit 1-2 audiotaped consultations before and after training. Doctors completed outcome measures before and after completing the post-training cohort recruitment. RESULTS Ninety-five consultation interactions were audiotaped. Doctors strongly endorsed the training. ANZ intervention doctors demonstrated a significant increase in collaborative communication (P = 0.03). There was no effect of training on other doctor behaviours. Trained doctors did not demonstrate reduced stress and burnout. Patient outcomes are presented elsewhere. CONCLUSIONS Training can improve some aspects of the process of obtaining informed consent. Methods to increase the impact of training are required and may include longer training and more intensive follow-up.
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Affiliation(s)
- P Butow
- Centre for Medical Psychology and Evidence-based Decision-Making (CeMPED), University of Sydney, Sydney, NSW, Australia
| | - R Brown
- Department of Social and Behavioral Health, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - J Aldridge
- International Breast Cancer Study Group (IBCSG) Statistical Centre, Department of Biostatistics & Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - I Juraskova
- Centre for Medical Psychology and Evidence-based Decision-Making (CeMPED), University of Sydney, Sydney, NSW, Australia
| | - P Zoller
- Quality of Life Office, IBCSG Coordinating Center and Department of Medical Oncology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - F Boyle
- Pam McLean Centre, Northern Clinical School, University of Sydney, Sydney, NSW, Australia
| | - M Wilson
- Department of Social and Behavioral Health, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - J Bernhard
- Quality of Life Office, IBCSG Coordinating Center and Department of Medical Oncology, Inselspital, Bern University Hospital, Bern, Switzerland
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Hollada J, Marfori W, Tognolini A, Speier W, Ristow L, Ruehm SG. Successful patient recruitment in CT imaging clinical trials: what factors influence patient participation? Acad Radiol 2014; 21:52-7. [PMID: 24331264 DOI: 10.1016/j.acra.2013.09.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 09/11/2013] [Accepted: 09/11/2013] [Indexed: 10/25/2022]
Abstract
RATIONALE AND OBJECTIVES Analyze factors that influence participation in research studies that use coronary computed tomography (CT) imaging. MATERIALS AND METHODS A 12-point survey using a questionnaire was conducted on 80 subjects, of whom 40 agreed to participate in a cardiovascular CT imaging research study (enrolling subjects) and 40 declined participation (non-enrolling subjects). Potential factors that motivated the acceptance or refusal of enrollment were evaluated using a 5-point Likert scale. The following aspects were addressed: (1) additional health information, (2) free imaging, (3) altruistic benefit to society, (4) monetary compensation, (5) radiation exposure, (6) role as an experimental subject, (7) possible loss of confidentiality, (8) contrast or investigational drug use, (9) premedication use, (10) blood draw or intravenous placement, (11) time commitment, and (12) personal medical opinion. Response distributions were obtained for each question and compared between enrolling and non-enrolling groups. RESULTS Enrolling subjects gave significantly higher ratings than non-enrolling subjects for the following factors: additional health information (P < .001), free imaging (P < .001), and the altruistic benefit to society (P < .001). For non-enrolling subjects, concern for possible drug use or contrast injection (P < .001), concern for possible premedication (P < .001), and personal availability or time commitment (P < .001) were all given significantly higher ratings. Concern for radiation exposure (P = .002) and personal medical opinion (P < .001) received significantly high ratings among both groups but did not differ between groups. CONCLUSIONS Several influential concerns and benefits were identified from potential research subjects. Knowledge of what influences patient participation in studies involving CT imaging may allow researchers to effectively address concerns and highlight the potential benefits related to participation.
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Catania C, Radice D, Spitaleri G, Adamoli L, Noberasco C, Delmonte A, Vecchio F, de Braud F, Toffalorio F, Goldhirsch A, De Pas T. The choice of whether to participate in a phase I clinical trial: increasing the awareness of patients with cancer. An exploratory study. Psychooncology 2013; 23:322-9. [DOI: 10.1002/pon.3424] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 09/06/2013] [Accepted: 09/11/2013] [Indexed: 01/29/2023]
Affiliation(s)
- C. Catania
- Clinical Pharmacology and New Drugs Development Division, Medical Oncology Department; European Institute of Oncology; Milan Italy
| | - D. Radice
- Epidemiology and Biostatistics Division; European Institute of Oncology; Milan Italy
| | - G. Spitaleri
- Clinical Pharmacology and New Drugs Development Division, Medical Oncology Department; European Institute of Oncology; Milan Italy
| | - L. Adamoli
- Clinical Pharmacology and New Drugs Development Division, Medical Oncology Department; European Institute of Oncology; Milan Italy
| | - C. Noberasco
- Clinical Pharmacology and New Drugs Development Division, Medical Oncology Department; European Institute of Oncology; Milan Italy
| | - A. Delmonte
- Clinical Pharmacology and New Drugs Development Division, Medical Oncology Department; European Institute of Oncology; Milan Italy
| | - F. Vecchio
- Clinical Pharmacology and New Drugs Development Division, Medical Oncology Department; European Institute of Oncology; Milan Italy
| | - F. de Braud
- Medical Oncology Unit 1; Fondazione IRCCS Istituto Nazionale dei Tumori; Milan Italy
| | - F. Toffalorio
- Clinical Pharmacology and New Drugs Development Division, Medical Oncology Department; European Institute of Oncology; Milan Italy
| | - A. Goldhirsch
- Department of Medicine; European Institute of Oncology; Milan Italy
| | - T. De Pas
- Clinical Pharmacology and New Drugs Development Division, Medical Oncology Department; European Institute of Oncology; Milan Italy
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Brown RF, Bylund CL, Li Y, Edgerson S, Butow P. Testing the utility of a cancer clinical trial specific Question Prompt List (QPL-CT) during oncology consultations. PATIENT EDUCATION AND COUNSELING 2012; 88:311-7. [PMID: 22390854 PMCID: PMC3376695 DOI: 10.1016/j.pec.2012.02.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 02/01/2012] [Accepted: 02/06/2012] [Indexed: 05/28/2023]
Abstract
OBJECTIVE A Question Prompt List (QPL) is a proven, simple intervention to aid patients to be active participants in consultations with their physicians by asking questions. We aimed to further develop and test the efficacy of a targeted QPL for clinical trials (QPL-CT). METHODS Breast, Lung and Genitourinary cancer patients who were facing a discussion about a therapeutic clinical trial completed short pre- and post-consultation questionnaires and used the QPL-CT in their discussions with their oncologists. RESULTS 30 participants were recruited from 6 oncologists. All QPL-CT questions were selected by at least one-third of participants. Participants mostly wanted and asked questions about personal trial benefit. Oncologists provided information about personal benefit to varying degrees, thus patients did not ask some questions. Patients were still left with some unasked and unanswered questions. CONCLUSION The QPL-CT has potential as a simple, inexpensive intervention to aid such communication. Further investigation is needed to demonstrate the efficacy of the QPL-CT in improving cancer patient outcomes. PRACTICE IMPLICATIONS These preliminary finding suggest that important areas of clinical trials are overlooked in clinical consultations. The QPL-CT may be an effective method to encourage oncologists to endorse patient question asking about clinical trials and prompt patient questions.
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Affiliation(s)
- Richard F Brown
- Department of Social and Behavioral Health, Virginia Commonwealth University School of Medicine, Richmond VA 23298-0149, USA.
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Gleason MEJ, Harper FWK, Eggly S, Ruckdeschel JC, Albrecht TL. The influence of patient expectations regarding cure on treatment decisions. PATIENT EDUCATION AND COUNSELING 2009; 75:263-9. [PMID: 19147315 PMCID: PMC3785099 DOI: 10.1016/j.pec.2008.10.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Revised: 09/30/2008] [Accepted: 10/23/2008] [Indexed: 05/20/2023]
Abstract
OBJECTIVE To test whether cancer patients' expectations for cure prior to interacting with their oncologist influence their decisions to follow treatment recommendations. Further, to test whether patients' expectations for cure are affected by the strength of the oncologist-patient alliance or the extent to which companions (if present) share patients' expectations for cure. METHODS Interactions of 101 patients (and 114 companions) with oncologists about treatment were coded for the strength of the oncologist-patient alliance. Prior to the interaction, patients and companions reported expectations about whether the patient would be cured of cancer. After the interaction, patients reported whether they intended to follow the recommended treatment. RESULTS Patients who expected a cure were more likely to report an intention to follow oncologists' treatment recommendation when the strength of their alliance with their oncologist was weaker (B=-0.51, p<.05). Patients whose expectations for cure matched their companions' expectations were less likely to report intentions to follow treatment recommendations (B=-0.28, p<.05). CONCLUSION Patients who have an expectation of being cured of cancer prior to meeting with their oncologist are more likely to intend to follow recommended treatment when their alliance with the oncologist is weaker and their companions do not believe they will be cured. PRACTICE IMPLICATIONS To better understand patient treatment decisions and improve overall cancer care, oncologists should be aware of the complex ways that patients' expectations about cure influence treatment choices.
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Affiliation(s)
- Marci E J Gleason
- Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, Michigan 48201, United States.
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Road Map for Maintaining Career Satisfaction and Balance in Surgical Oncology. J Am Coll Surg 2008; 207:435-42. [DOI: 10.1016/j.jamcollsurg.2008.03.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Revised: 03/25/2008] [Accepted: 03/25/2008] [Indexed: 11/20/2022]
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Albrecht TL, Eggly SS, Gleason MEJ, Harper FWK, Foster TS, Peterson AM, Orom H, Penner LA, Ruckdeschel JC. Influence of clinical communication on patients' decision making on participation in clinical trials. J Clin Oncol 2008; 26:2666-73. [PMID: 18509178 DOI: 10.1200/jco.2007.14.8114] [Citation(s) in RCA: 177] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To investigate how communication among physicians, patients, and family/companions influences patients' decision making about participation in clinical trials. PATIENTS AND METHODS We video recorded 235 outpatient interactions occurring among oncologists, patients, and family/companions (if present) at two comprehensive cancer centers. We combined interaction analysis of the real-time video-recorded observations (collected at Time 1) with patient self-reports (Time 2) to determine how communication about trial offers influenced accrual decisions. RESULTS Clinical trials were explicitly offered in 20% of the interactions. When offers were made and patients perceived they were offered a trial, 75% of patients assented. Observed messages (at Time 1) directly related to patients' self-reports regarding their decisions (2 weeks later), and how they felt about their decisions and their physicians. Specifically, messages that help build a sense of an alliance (among all parties, including the family/companions), provide support (tangible assistance and reassurance about managing adverse effects), and provide medical content in language that patients and family/companions understand are associated with the patient's decision and decision-making process. CONCLUSION In two urban, National Cancer Institute-designated comprehensive cancer centers, a large percentage of patients are not offered trials. When offered a trial, most patients enroll. The quality and quantity of communication occurring among the oncologist, patient, and family/companion when trials are discussed matter in the patient's decision-making process. These findings can help increase physician awareness of the ways that messages and communication behaviors can be observed and evaluated to improve clinical practice and research.
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Affiliation(s)
- Terrance L Albrecht
- Barbara Ann Karmanos Cancer Institute, 4100 John R St, Detroit, MI 48201, USA.
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Eggly S, Albrecht TL, Harper FWK, Foster T, Franks MM, Ruckdeschel JC. Oncologists' recommendations of clinical trial participation to patients. PATIENT EDUCATION AND COUNSELING 2008; 70:143-148. [PMID: 17983722 PMCID: PMC2248277 DOI: 10.1016/j.pec.2007.09.019] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2007] [Accepted: 09/22/2007] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To describe the frequency, context and type of oncologists' recommendations to patients that they participate in a clinical trial and to analyze the relationship between recommendations and patients' decisions to participate. METHODS Data included 38 video recorded outpatient interactions during which 15 oncologists invited 38 patients to participate in clinical trials. We described the frequency, context, and type of oncologists' recommendations and analyzed the relationship between these factors and patient decisions to participate and socio-demographic characteristics. RESULTS Sixty-eight percent (n=26) of the 38 interactions included an explicit recommendation. Most recommendations were unprompted by patients and/or companions and were tailored to individual patients. A significant relationship was found between recommendations and patients' decisions to participate. Positive trends were found between receiving a recommendation and being female and having higher education. CONCLUSION Oncologists routinely make recommendations to patients during the presentation of clinical trials. These recommendations may influence patients' decisions and may occur more frequently with some demographic groups. PRACTICE IMPLICATIONS Oncologists should be aware of the potential influence of their recommendations when discussing clinical trials with patients.
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Affiliation(s)
- Susan Eggly
- Program in Communication and Behavioral Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI 48201, USA.
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Eggly S, Penner LA, Greene M, Harper FWK, Ruckdeschel JC, Albrecht TL. Information seeking during "bad news" oncology interactions: Question asking by patients and their companions. Soc Sci Med 2006; 63:2974-85. [PMID: 16962218 DOI: 10.1016/j.socscimed.2006.07.012] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2005] [Indexed: 11/20/2022]
Abstract
Previous research has investigated patient question asking in clinical settings as a strategy of information seeking and as an indicator of the level of active patient participation in the interaction. This study investigates questions asked by patients and their companions during stressful encounters in the oncology setting in the USA. We transcribed all questions patients and companions asked the oncologist during 28 outpatient interactions in which "bad news" was discussed (n = 705) and analyzed them for frequency and topic. Additionally, we analyzed the extent to which personal and demographic characteristics and independently obtained ratings of the oncologist-patient/companion relationships were related to question asking. Findings demonstrated that at least one companion was present in 24 (86%) of the 28 interactions and companions asked significantly more questions than patients. The most frequently occurring topics for both patients and companions were treatment, diagnostic testing, diagnosis, and prognosis. In general, personal and demographic characteristics were unrelated to question asking, but older patients asked fewer questions, while more educated patients asked more questions. With regard to ratings of the quality of the dyadic relationships, results showed that "trust" between the physician and companions was positively correlated and "conversational dominance by physician" was negatively correlated with the frequency of companion questions. Additionally, positive ratings of the relationship between physicians and companions were correlated with fewer patient questions. This study demonstrates that companions are active participants in stressful oncology interactions. Future research and physician training in communication would benefit from expanding the focus beyond the patient-physician dyad to the roles and influence of multiple participants in medical interactions.
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Affiliation(s)
- Susan Eggly
- Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA.
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Avis NE, Smith KW, Link CL, Hortobagyi GN, Rivera E. Factors associated with participation in breast cancer treatment clinical trials. J Clin Oncol 2006; 24:1860-7. [PMID: 16622260 DOI: 10.1200/jco.2005.03.8976] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE It is well established that recruitment to clinical trials (CTs) is difficult and time consuming. This article reports on factors related to CT participation among women who were invited to participate in a CT for breast cancer. PATIENTS AND METHODS Breast cancer patients who were eligible for a CT were identified by 16 different cancer centers. After their invitation to participate in a trial, patients who were undecided about participation in a CT were recruited into the present study at that time. After a patient made a decision about trial participation, a telephone interview was conducted to assess knowledge of CTs, perceived benefits and drawbacks of CTs, and personal factors affecting the women's decision regarding participation. RESULTS A total of 208 patients participated in the study. Fifty-eight percent of the patients decided to participate in a trial. Logistic regression analyses showed that the factors best explaining participation were trial phase, perceived drawbacks, time and travel considerations, therapeutic benefit of trial, and physician recommendation. Participation rates were similar for both phase I and phase III trials. However, a higher percentage of women recruited to phase II trials accepted. CONCLUSION This study suggests that reducing drawbacks of CT participation, particularly travel time, and improving physician communication of trials are needed to increase trial participation.
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Affiliation(s)
- Nancy E Avis
- Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1063, USA.
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Ellington L, Wahab S, Sahami Martin S, Field R, Mooney KH. Factors that influence Spanish- and English-speaking participants' decision to enroll in cancer randomized clinical trials. Psychooncology 2006; 15:273-84. [PMID: 15973647 DOI: 10.1002/pon.943] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Cancer randomized clinical trial (RCT) participation is low, particularly among ethnic and racial minorities. Hispanic enrollment is far below their representation in the US population, yet their cancer burden is higher. Little is known from the patient perspective about factors which influence the decision to enroll in RCTs. We asked Spanish- and English-speaking individuals what factors influence decisions about cancer RCT participation. Eight focus groups were conducted with 55 participants (25 Spanish and 30 English-speaking). The groups were taped, transcribed, and analyzed for themes. Six major themes emerged: patient-provider communication, personal relationship with provider, involvement of significant others in decision making, role of faith, need for information, and impact of discrimination on decision making. Both similarities (e.g. need for comprehensive information) and differences (e.g. need for provider acknowledgement of emotional and spiritual concerns) were found between Spanish- and English-speaking participants. Among Spanish-speaking participants, level of education was differentially related to decision-making themes. Implications for providers are discussed.
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Affiliation(s)
- Lee Ellington
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT 84112-5850, USA.
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Albrecht TL, Kuerer H, Ruckdeschel JC, Mendez J, Harper F. Transdisciplinary studies of surgical oncology trial accrual. Cancer 2006; 107:171-4. [PMID: 16721802 DOI: 10.1002/cncr.21966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND A key objective of the National Institutes of Health Roadmap Initiative during the past 2 years has been to address scientific problems and issues through innovative research collaborations that cut across disciplines, traditions, and agendas. METHODS Recognizing an opportunity to focus on the growing problem of low accrual to cancer surgical trials, the authors organized a multidisciplinary network of 21 clinical researchers and social/behavioral scientists to meet, review the issues, and organize working groups to study the problem. The authors, as representatives of the Karmanos Cancer Institute (Detroit, MI) and the American College of Surgeons Oncology Group, were awarded a Roadmap-affiliated grant from the National Cancer Institute under the "Meetings and Networks for Methodological Development in Interdisciplinary Research" funding mechanism. RESULTS The overarching objective that guided the methodological developments of this network was to apply state-of-the-science methodologies and analytical strategies to examine the biobehavioral and interpersonal factors that facilitate or impede patients' treatment decision-making. CONCLUSIONS In this brief report, the authors describe the objectives of their multidisciplinary network and their progress to date.
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Affiliation(s)
- Terrance L Albrecht
- Department of Family Medicine, Communication and Behavioral Oncology, Barbara Ann Karmanos Cancer Institute/Wayne State University School of Medicine, Detroit, Michigan 48201, USA.
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