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Nelson JE, Gonzalez CJ, Alvarado A, Costas-Muniz R, Epstein AS, Hoque A, Gany FM. Beyond translation: Transcreation of a clinicians' guide to structure discussions about health-related values with Latinx patients throughout cancer. PATIENT EDUCATION AND COUNSELING 2024; 120:108100. [PMID: 38104422 PMCID: PMC11019714 DOI: 10.1016/j.pec.2023.108100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE This study aimed to ensure accurate translation and cultural appropriateness of a guide designed to help oncology clinicians provide person-centered care to Spanish-speaking Latinx patients with cancer. METHODS Initial translation of a clinician-patient values discussion guide in open-ended question format ("Guide") was pretested in interviews with 27 Spanish-speaking individuals, followed by national expert panel review. At three sites, semi-structured, in-depth, audio-recorded interviews in the participant's preferred language (Spanish/English) were then conducted with Latinx patients receiving systemic treatment for a solid tumor malignancy and family joining them at clinic. RESULTS Interviews of 43 patient/family participants representing diverse Latinx communities addressed the Guide's understandability, acceptability, relevance and responsiveness. Rapid analysis of interviews contributed to cultural adaptation/transcreation of the Guide for a pilot interventional trial. CONCLUSION Moving beyond translation to transcreation can help promote inclusion, equity, and cultural sensitivity in oncologic care/communication. PRACTICE IMPLICATIONS Clinicians now have a linguistically- and culturally-adapted guide including questions and prompts to help structure discussions in Spanish or English of health-related values with Latinx patients receiving oncologic care.
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Affiliation(s)
- Judith E Nelson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, USA; Weill Cornell Medical College, USA.
| | - Carlos J Gonzalez
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, USA
| | - Angelica Alvarado
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, USA
| | - Rosario Costas-Muniz
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, USA; Weill Cornell Medical College, USA
| | - Andrew S Epstein
- Department of Medicine, Memorial Sloan Kettering Cancer Center, USA; Weill Cornell Medical College, USA
| | - Afshana Hoque
- Department of Medicine, Memorial Sloan Kettering Cancer Center, USA
| | - Francesca M Gany
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, USA; Weill Cornell Medical College, USA
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Thomas TH, Bender C, Donovan HS, Murray PJ, Taylor S, Rosenzweig M, Sereika SM, Brufsky A, Schenker Y. The feasibility, acceptability, and preliminary efficacy of a self-advocacy serious game for women with advanced breast or gynecologic cancer. Cancer 2023; 129:3034-3043. [PMID: 37243943 DOI: 10.1002/cncr.34887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/13/2023] [Accepted: 05/05/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Cancer clinicians and systems aim to provide patient-centered care, but not all patients have the self-advocacy skills necessary to ensure their care reflects their needs and priorities. This study examines the feasibility, acceptability, and preliminary efficacy of a self-advocacy serious game (an educational video game) intervention in women with advanced breast or gynecologic cancer. METHODS Women with recently diagnosed (<3 months) metastatic breast or advanced gynecologic cancer were randomized 2:1 to receive a tablet-based serious game (Strong Together) (n = 52) or enhanced care as usual (n = 26). Feasibility was based on recruitment, retention, data completion, and intervention engagement. Acceptability was assessed via a postintervention questionnaire and exit interview. Preliminary efficacy was assessed on the basis of change scores from baseline to 3 and 6 months in self-advocacy (Female Self-Advocacy in Cancer Survivorship Scale) using intention-to-treat analysis. RESULTS Seventy-eight women (55.1% with breast cancer; 44.9% with gynecologic cancer) were enrolled. Feasibility was demonstrated by satisfactory recruitment (69% approach-to-consent rate; 93% enroll-to-randomize rate), retention (90% and 86% at 3 and 6 months, respectively; 85% data completion), and intervention engagement (84% completed ≥75% of the game). Participants endorsed the intervention's (75%) and trial's (87%) acceptability. Participants in the intervention group experienced significant improvements in self-advocacy at 3 and 6 months compared to participants in the control group. CONCLUSIONS Strong Together is feasible and acceptable among women with advanced breast or gynecologic cancer. This intervention demonstrates promising evidence of clinical efficacy. A future confirmatory trial is warranted to test the efficacy of the intervention for patient and health system outcomes.
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Affiliation(s)
- Teresa Hagan Thomas
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Palliative Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Catherine Bender
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Heidi S Donovan
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- University of Pittsburgh Medical Center Magee-Womens Hospital, Pittsburgh, Pennsylvania, USA
| | - Patty Jo Murray
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sarah Taylor
- University of Pittsburgh Medical Center Magee-Womens Hospital, Pittsburgh, Pennsylvania, USA
- Division of Hematology/Oncology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Margaret Rosenzweig
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- University of Pittsburgh Medical Center Magee-Womens Hospital, Pittsburgh, Pennsylvania, USA
| | - Susan M Sereika
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Adam Brufsky
- University of Pittsburgh Medical Center Magee-Womens Hospital, Pittsburgh, Pennsylvania, USA
- Division of Hematology/Oncology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yael Schenker
- Palliative Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Epstein AS, Knezevic A, Romano DR, Hoque A, Raj N, Reidy D, Rosa WE, Cruz E, Calderon C, O'Shaughnessy S, Sansone A, Okpako M, Nelson JE. Patient Portals to Elicit Essential Patient-Reported Elements of Communication Supporting Person-Centered Oncologic Care: A Pilot Study of the PERSON Approach. JCO Clin Cancer Inform 2023; 7:e2300125. [PMID: 37890120 PMCID: PMC10642868 DOI: 10.1200/cci.23.00125] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/14/2023] [Accepted: 09/06/2023] [Indexed: 10/29/2023] Open
Abstract
PURPOSE Patient portal technology offers important new opportunities to support person-centered clinician-patient communication. METHODS Questionnaires relating to understanding of illness and treatment intent were sent quarterly via portal to all patients scheduled for follow-up in GI medical oncology clinics. For patients in selected clinics, items eliciting health-related values were added. Patient responses were available to all oncology team members in the electronic health record. Workflow and content of clinician-patient discussions about illness, treatment, and care goals stayed within clinicians' discretion. Feasibility (patient response rate), patient understanding, acceptability (three-item patient questionnaire), and efficacy (quality of clinician communication) were evaluated. RESULTS From May 2021 through December 2022, a total of 12,233 questionnaires about illness/treatment understanding were sent to 6,325 patients (one to six per patient), with 97% response, including 9,358 with both open- and closed-ended responses. Fewer than 0.1% of patients indicated distress related to the questionnaire/process. Open-ended responses complemented closed-ended answers by revealing prognostic awareness and illness concerns. Of 48 patients approached to complete the full questionnaire including values items via portal, 15 first received and completed them in clinic (5 on iPad, 10 on paper), while 33 received and 27 (82%) completed the portal questionnaire. Patients found the portal process acceptable, and ratings of clinician communication were higher after clinic visits informed by patients' questionnaire responses (average prescore 6.8 v 5.9 post; P = .03). CONCLUSION Almost all patients in this large GI cancer cohort responded via the portal about their understanding of illness and treatment goals. Eliciting their personal values by portal was also feasible, accepted by patients, and improved patient ratings of clinicians' communication. Portals represent a promising tool for scaling assessment of essential patient-reported elements of person-centered communication.
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Affiliation(s)
- Andrew S. Epstein
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | | | | | - Afshana Hoque
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nitya Raj
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Diane Reidy
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | | - Molly Okpako
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Judith E. Nelson
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
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Goswami P. Impact of advance care planning and end-of-life conversations on patients with cancer: An integrative review of literature. J Nurs Scholarsh 2023; 55:272-290. [PMID: 35946931 DOI: 10.1111/jnu.12804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/24/2022] [Accepted: 07/08/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE The purpose was to review published articles to examine the impact of advance care planning (ACP) and end-of-life (EOL) conversations on patients with cancer, and aimed to compare the findings for congruency with the goals of ACP. DESIGN AND METHOD The study was guided by Whittemore and Knafl's integrative review methodology. Articles published between 2015 to 2020 were identified through electronic databases. The search included: Cumulative Index for Nursing Allied Health Literature (CINAHL), PubMed, MEDLINE-Ovid, and MEDLINE full text, and using the MeSH terms. Two hundred and five (205) articles were identified and screened for eligibility, and 15 articles were appraised. FINDINGS The fifteen (15) articles that met the inclusion criteria included five (5) qualitative, eight (8) quantitative, and two (2) mixed methods. The review analysis revealed six themes emerged in three categories: cancer patients' experience with advance care planning (1) patients' prognostic awareness, (2) decision making; cancer patients' perceived outcomes with advance care planning (3) patient-provider relationship, (4) concordance in care based on goals, and cancer patients' propositions related to advance care planning, (5) timings of advance care planning discussions, and (6) support during ACP and/or EOL conversations. CONCLUSION ACP and EOL conversations play a critical role in cancer patients' awareness of their disease and prognosis and help them in making end-of-life care decisions. CLINICAL RELEVANCE There exists a need for earlier ACP and EOL conversations with cancer patients with emotional support during these conversations.
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Affiliation(s)
- Poonam Goswami
- Department of Investigational Cancer Therapeutics, UT MD Anderson Cancer Center, Houston, Texas, USA.,Texas Woman's University, Denton, Texas, USA
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Thomas TH, Murray PJ, Rosenzweig M, Taylor S, Brufsky A, Bender C, Larkin M, Schenker Y. "I was never one of those people who just jumped right in for me": patient perspectives on self-advocacy training for women with advanced cancer. Support Care Cancer 2023; 31:96. [PMID: 36598659 PMCID: PMC9811054 DOI: 10.1007/s00520-022-07531-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 11/19/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Patients with advanced cancer experience many complicated situations that can make self-advocacy (defined as the ability speak up for yourself in the face of a challenge) difficult. Few self-advocacy interventions exist, and most are atheoretical with minimal patient engagement. The purpose of this study is to describe participant perspectives of a novel, self-advocacy serious game intervention called Strong Together. METHODS This was a qualitative cross-sectional descriptive study among women receiving cancer care at an academic cancer center within 3 months of an advanced gynecologic or breast cancer diagnosis. Participants randomized to receive the intervention completed one-on-one semi-structured interviews 3-months post Strong Together and had the option to share voice journals about their experiences. Inductive qualitative approaches were used to descriptively analyze transcripts and voice journals. Descriptive content analysis approaches were used to group similar codes together into themes summarizing participants' experiences engaging with the Strong Together intervention. RESULTS Participants (N = 40) reported that the Strong Together intervention was acceptable, noting that it was realistic and reflective of their personal experiences. Overarching themes included seeing myself in most scenarios and wanting more content; giving me the go ahead to expect more; offering ideas for how to stand up for myself; reinforcing what I am already doing; and reminding me of what I have. Participants suggested adding additional content including diverse characters. CONCLUSION This study demonstrated that women with advanced cancer were receptive to a self-advocacy skills-building intervention. Future research should explore the mechanisms linking serious games to learning and health outcomes.
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Affiliation(s)
- Teresa Hagan Thomas
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Suite 440, Pittsburgh, PA 15261 USA ,Palliative Research Center (PaRC), University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA 15213 USA
| | - Patty Jo Murray
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Suite 440, Pittsburgh, PA 15261 USA
| | - Margaret Rosenzweig
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Suite 440, Pittsburgh, PA 15261 USA ,Palliative Research Center (PaRC), University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA 15213 USA ,University of Pittsburgh Medical Center Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213 USA
| | - Sarah Taylor
- University of Pittsburgh Medical Center Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213 USA ,Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of Pittsburgh, 1218 Scaife Hal, 3550 Terrace Street, Pittsburgh, PA 15261 USA
| | - Adam Brufsky
- University of Pittsburgh Medical Center Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213 USA ,Division of Hematology/Oncology, School of Medicine, University of Pittsburgh, 1218 Scaife Hal, 3550 Terrace Street, Pittsburgh, PA 15261 USA
| | - Catherine Bender
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Suite 440, Pittsburgh, PA 15261 USA
| | - Mikayla Larkin
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, 100 Technology Drive, Pittsburgh, PA 15219 USA
| | - Yael Schenker
- Palliative Research Center (PaRC), University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA 15213 USA ,Division of General Internal Medicine, School of Medicine, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA 15213 USA
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Liu D, Zhang L, Li J, Wang Z, Liu X, Zhang Q. Verification of the Mandarin Chinese version of Advance Care Planning Engagement Survey Scale in community-dwelling older people. Int J Older People Nurs 2023; 18:e12502. [PMID: 36083228 DOI: 10.1111/opn.12502] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 07/08/2022] [Accepted: 07/25/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Advance care planning (ACP) has become increasingly critical for older people. The Advance Care Planning Engagement Survey (ACPES) develops targeted interventions for older people by measuring ACP-related behaviours, while previous studies focus only on advance directives. Moreover, while ACPES has English and Dutch versions, it does not yet have a Mandarin Chinese version (ACPES-MC) that can be used for Chinese populations. OBJECTIVES To translate the ACPES into Mandarin Chinese and test its reliability and validity in community-dwelling older people with chronic diseases. METHODS The English version of the ACPES was translated into Mandarin Chinese using Functional Assessment of Chronic Illness Therapy. Four communities were recruited in central China (N = 450) by convenience sampling. Internal consistency and construct validity were used to evaluate the reliability and validity of the ACPES-MC. RESULTS The ACPES-MC consists of 34 items across five domains, with good internal consistency (0.817), with each dimension ranging from 0.606 to 0.881; exploratory factor analysis was distributed to four different factors and the total variance explained was 63.537%; and confirmatory factor analysis results showed that χ2 = 3791.131 (p < .001), χ2 /df = 1.106, CFI = 0.980, IFI = 0.980, NFI = 0.827 and RMR = 0.027, indicating a good model fit to previous factor structures. CONCLUSIONS The ACPES-MC is an effective and reliable tool that can measure the ACP-related behaviour stage of community-dwelling older people and evaluate the effect of ACP intervention. IMPLICATIONS FOR PRACTICE The ACPES-MC can be used in healthcare to identify potential ACP-related behaviours in community-dwelling older people with chronic diseases, including native and ethnic Chinese, evaluate their behaviour change stages and promote the application of ACP.
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Affiliation(s)
- Dongling Liu
- School of Nursing, Zhengzhou University, Zhengzhou, China
| | - Lingli Zhang
- School of Nursing, Zhengzhou University, Zhengzhou, China
| | - Jiayin Li
- School of Nursing, Zhengzhou University, Zhengzhou, China
| | - Zicheng Wang
- School of Nursing, Zhengzhou University, Zhengzhou, China
| | - Xuebing Liu
- School of Nursing, Zhengzhou University, Zhengzhou, China
| | - Qiongwen Zhang
- School of Nursing, Zhengzhou University, Zhengzhou, China
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Malhotra C, Shafiq M, Batcagan-Abueg APM. What is the evidence for efficacy of advance care planning in improving patient outcomes? A systematic review of randomised controlled trials. BMJ Open 2022. [PMCID: PMC9301802 DOI: 10.1136/bmjopen-2021-060201] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives To conduct an up-to-date systematic review of all randomised controlled trials assessing efficacy of advance care planning (ACP) in improving patient outcomes, healthcare use/costs and documentation. Design Narrative synthesis conducted for randomised controlled trials. We searched electronic databases (MEDLINE/PubMed, Embase and Cochrane databases) for English-language randomised or cluster randomised controlled trials on 11 May 2020 and updated it on 12 May 2021 using the same search strategy. Two reviewers independently extracted data and assessed methodological quality. Disagreements were resolved by consensus or a third reviewer. Results We reviewed 132 eligible trials published between 1992 and May 2021; 64% were high-quality. We categorised study outcomes as patient (distal and proximal), healthcare use and process outcomes. There was mixed evidence that ACP interventions improved distal patient outcomes including end-of-life care consistent with preferences (25%; 3/12 with improvement), quality of life (0/14 studies), mental health (21%; 4/19) and home deaths (25%; 1/4), or that it reduced healthcare use/costs (18%; 4/22 studies). However, we found more consistent evidence that ACP interventions improve proximal patient outcomes including quality of patient–physician communication (68%; 13/19), preference for comfort care (70%; 16/23), decisional conflict (64%; 9/14) and patient-caregiver congruence in preference (82%; 18/22) and that it improved ACP documentation (a process outcome; 63%; 34/54). Conclusion This review provides the most comprehensive evidence to date regarding the efficacy of ACP on key patient outcomes and healthcare use/costs. Findings suggest a need to rethink the main purpose and outcomes of ACP. PROSPERO registration number CRD42020184080.
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Affiliation(s)
- Chetna Malhotra
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
| | - Mahham Shafiq
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
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Agarwal R, Shin P, Knezevic A, Nelson JE, Romano DR, Bernal C, Desai AV, Epstein AS. Accuracy of curability expectations in patients with gastrointestinal cancers. Cancer Med 2022; 12:20-29. [PMID: 35959986 PMCID: PMC9844646 DOI: 10.1002/cam4.4947] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/03/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Assessment of illness and treatment understanding among cancer patients has largely focused on those with advanced disease. Less is known about patient expectations at earlier stages of cancer and potential modifiers of accurate understanding. METHODS We assessed accuracy of cure expectations in patients across all stages with gastrointestinal (GI) cancers. Accuracy was determined by independent reviews of patient health records by oncologists on the investigative team. Impact on cure accuracy of selected clinical variables and health-information preferences was analyzed. RESULTS Hundred and thirty five patients were included for analysis, with 100% interrater agreement for accuracy between oncologist reviewers. Sixety five patients (48%) had accurate cure expectations from their cancer treatment. Accuracy was lower in Stage IV versus Stage I-III disease (35% vs. 63%, p < 0.01), lower in unresectable versus resectable disease (35% vs. 67%, p < 0.01), and higher in patients with early-stage disease who received adjuvant chemotherapy versus those who did not (78% vs. 53%, p = 0.04). Accuracy did not differ by health-information preferences and remained stable over time. Of 63 patients who died, baseline accuracy differed by location of death (p = 0.03), with greater accuracy in those who died with home hospice (56%). Accuracy was lower in those who were hospitalized in the last 30 days of life versus those who were not (25% vs. 59%, p = 0.01). CONCLUSIONS Inaccurate cure expectations are prevalent across all stages of GI cancers, but particularly among those with metastatic or unresectable disease. High-quality, iterative communication strategies may facilitate patient illness and treatment understanding throughout the disease course.
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Affiliation(s)
- Rajiv Agarwal
- Department of MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Paul Shin
- Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | | | - Judith E. Nelson
- Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
- Weill Cornell Medical CollegeNew YorkNew YorkUSA
| | | | - Camila Bernal
- Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Anjali V. Desai
- Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
- Weill Cornell Medical CollegeNew YorkNew YorkUSA
| | - Andrew S. Epstein
- Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
- Weill Cornell Medical CollegeNew YorkNew YorkUSA
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Lynch KA, Bernal C, Romano DR, Shin P, Nelson JE, Okpako M, Anderson K, Cruz E, Desai AV, Klimek VM, Epstein AS. Navigating a newly diagnosed cancer through clinician-facilitated discussions of health-related patient values: a qualitative analysis. BMC Palliat Care 2022; 21:29. [PMID: 35249532 PMCID: PMC8898465 DOI: 10.1186/s12904-022-00914-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 02/04/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Advance care planning, the process through which patient values and goals are explored and documented, is a core quality indicator in cancer care. However, patient values are predominantly elicited at the end of life; patient values earlier in serious illness are not clearly delineated. The objective of this analysis is to assess the content of patient-verified summaries of health-related values among newly diagnosed cancer outpatients in order to develop a theoretical framework to guide future values discussions and optimize person-centered oncologic care. METHODS Values summaries among patients with gastrointestinal (GI) cancers or myelodysplastic syndrome (MDS) were extracted from the medical record. Modified grounded theory analysis included interdisciplinary team coding of values summaries to identify key domains; code categorization; and identification of thematic constructs during successive consensus meetings. A final round of coding stratified themes by disease type. RESULTS Analysis of 128 patient values summary documents from 67 patients (gastrointestinal [GI] cancers, n = 49; myelodysplastic syndrome [MDS], n = 18) generated 115 codes across 12 categories. Resultant themes demonstrated patients' focus on retaining agency, personhood and interpersonal connection amidst practical and existential disruption caused by cancer. Themes coalesced into a theoretical framework with 5 sequenced constructs beginning with the cancer diagnosis, leading to 3 nesting constructs of individual identity (character), interpersonal (communication) preferences and needs, and social identity (connection), signifying sources of meaning and fulfillment. Values differences between GI cancer and MDS patients-including greater focus on normalcy, prognosis, and maintaining professional life among GI patients-reflected the distinct therapeutic options and prognoses across these disease groups. CONCLUSIONS Patient values reflect goals of meaning-making and fulfillment through individual agency and interpersonal supports in the setting of a newly diagnosed cancer. Early, nurse-led values discussions provide important and patient-specific data that are informative and likely actionable by clinicians in the delivery of person-centered care. Values can also facilitate discussions between patients and families and clarify patient preferences.
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Affiliation(s)
- Kathleen A Lynch
- Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY, 10022, USA.
| | - Camila Bernal
- Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY, 10022, USA
| | - Danielle R Romano
- Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY, 10022, USA
| | - Paul Shin
- Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY, 10022, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Judith E Nelson
- Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY, 10022, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Molly Okpako
- Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY, 10022, USA
| | - Kelley Anderson
- Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY, 10022, USA
| | - Elizabeth Cruz
- Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY, 10022, USA
| | - Anjali V Desai
- Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY, 10022, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Virginia M Klimek
- Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY, 10022, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Andrew S Epstein
- Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY, 10022, USA
- Weill Cornell Medical College, New York, NY, USA
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Michael NG, Georgousopoulou E, Hepworth G, Melia A, Tuohy R, Sulistio M, Kissane D. Patient-caregiver dyads advance care plan value discussions: randomised controlled cancer trial of video decision support tool. BMJ Support Palliat Care 2022:bmjspcare-2021-003240. [PMID: 35078875 DOI: 10.1136/bmjspcare-2021-003240] [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] [Received: 06/15/2021] [Accepted: 01/01/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Uptake of advance care planning (ACP) in cancer remains low. An emphasis on personal value discussions and adoption of novel interventions may serve as the catalyst to increase engagement. This study examined the effectiveness of a video decision support tool (VDST) modelling values conversations in cancer ACP. METHODS This single site, open-label, randomised controlled trial allocated patient-caregiver dyads on a 1:1 ratio to VDST or usual care (UC). Previously used written vignettes were converted to video vignettes using standard methodology. We evaluated ACP document completion rates, understanding and perspectives on ACP, congruence in communication and preparation for decision-making. RESULTS Participants numbered 113 (60.4% response rate). The VDST did not improve overall ACP document completion (37.7% VDST; 36.7% UC). However, the VDST improved ACP document completion in older patients (≥70) compared with younger counterparts (<70) (OR=0.308, 95% CI 0.096 to 0.982, p=0.047), elicited greater distress in patients (p=0.015) and improved patients and caregivers ratings for opportunities to discuss ACP with health professionals. ACP improved concordance in communication (VDST p=0.006; UC p=0.045), more so with the VDST (effect size: VDST 0.7; UC 0.54). Concordance in communication also improved in both arms with age. CONCLUSION The VDST failed to improve ACP document completion rates but highlighted that exploring core patient values may improve concordance in patient-caregiver communication. Striving towards a more rigorous design of the VDST intervention, incorporating clinical outcome scenarios with values conversations may be the catalyst needed to progress ACP towards a more fulfilling process for those who partake in it. TRIAL REGISTRATION NUMBER ACTRN12620001035910.
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Affiliation(s)
- Natasha G Michael
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, Malvern, Victoria, Australia
- School of Medicine, The University of Notre Dame Australia, Sydney, New South Wales, Australia
| | - Ekavi Georgousopoulou
- School of Medicine, The University of Notre Dame Australia, Sydney, New South Wales, Australia
| | - Graham Hepworth
- Statistical Consulting Centre, The University of Melbourne, Carlton, Victoria, Australia
| | - Adelaide Melia
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, Malvern, Victoria, Australia
| | - Roisin Tuohy
- Faulty of Business and Economics, Monash University, Clayton, Victoria, Australia
| | - Merlina Sulistio
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, Malvern, Victoria, Australia
- School of Medicine, The University of Notre Dame Australia, Sydney, New South Wales, Australia
| | - David Kissane
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, Malvern, Victoria, Australia
- School of Medicine, The University of Notre Dame Australia, Sydney, New South Wales, Australia
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11
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Jull J, Köpke S, Smith M, Carley M, Finderup J, Rahn AC, Boland L, Dunn S, Dwyer AA, Kasper J, Kienlin SM, Légaré F, Lewis KB, Lyddiatt A, Rutherford C, Zhao J, Rader T, Graham ID, Stacey D. Decision coaching for people making healthcare decisions. Cochrane Database Syst Rev 2021; 11:CD013385. [PMID: 34749427 PMCID: PMC8575556 DOI: 10.1002/14651858.cd013385.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Decision coaching is non-directive support delivered by a healthcare provider to help patients prepare to actively participate in making a health decision. 'Healthcare providers' are considered to be all people who are engaged in actions whose primary intent is to protect and improve health (e.g. nurses, doctors, pharmacists, social workers, health support workers such as peer health workers). Little is known about the effectiveness of decision coaching. OBJECTIVES To determine the effects of decision coaching (I) for people facing healthcare decisions for themselves or a family member (P) compared to (C) usual care or evidence-based intervention only, on outcomes (O) related to preparation for decision making, decisional needs and potential adverse effects. SEARCH METHODS We searched the Cochrane Library (Wiley), Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), CINAHL (Ebsco), Nursing and Allied Health Source (ProQuest), and Web of Science from database inception to June 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs) where the intervention was provided to adults or children preparing to make a treatment or screening healthcare decision for themselves or a family member. Decision coaching was defined as: a) delivered individually by a healthcare provider who is trained or using a protocol; and b) providing non-directive support and preparing an adult or child to participate in a healthcare decision. Comparisons included usual care or an alternate intervention. There were no language restrictions. DATA COLLECTION AND ANALYSIS Two authors independently screened citations, assessed risk of bias, and extracted data on characteristics of the intervention(s) and outcomes. Any disagreements were resolved by discussion to reach consensus. We used the standardised mean difference (SMD) with 95% confidence intervals (CI) as the measures of treatment effect and, where possible, synthesised results using a random-effects model. If more than one study measured the same outcome using different tools, we used a random-effects model to calculate the standardised mean difference (SMD) and 95% CI. We presented outcomes in summary of findings tables and applied GRADE methods to rate the certainty of the evidence. MAIN RESULTS Out of 12,984 citations screened, we included 28 studies of decision coaching interventions alone or in combination with evidence-based information, involving 5509 adult participants (aged 18 to 85 years; 64% female, 52% white, 33% African-American/Black; 68% post-secondary education). The studies evaluated decision coaching used for a range of healthcare decisions (e.g. treatment decisions for cancer, menopause, mental illness, advancing kidney disease; screening decisions for cancer, genetic testing). Four of the 28 studies included three comparator arms. For decision coaching compared with usual care (n = 4 studies), we are uncertain if decision coaching compared with usual care improves any outcomes (i.e. preparation for decision making, decision self-confidence, knowledge, decision regret, anxiety) as the certainty of the evidence was very low. For decision coaching compared with evidence-based information only (n = 4 studies), there is low certainty-evidence that participants exposed to decision coaching may have little or no change in knowledge (SMD -0.23, 95% CI: -0.50 to 0.04; 3 studies, 406 participants). There is low certainty-evidence that participants exposed to decision coaching may have little or no change in anxiety, compared with evidence-based information. We are uncertain if decision coaching compared with evidence-based information improves other outcomes (i.e. decision self-confidence, feeling uninformed) as the certainty of the evidence was very low. For decision coaching plus evidence-based information compared with usual care (n = 17 studies), there is low certainty-evidence that participants may have improved knowledge (SMD 9.3, 95% CI: 6.6 to 12.1; 5 studies, 1073 participants). We are uncertain if decision coaching plus evidence-based information compared with usual care improves other outcomes (i.e. preparation for decision making, decision self-confidence, feeling uninformed, unclear values, feeling unsupported, decision regret, anxiety) as the certainty of the evidence was very low. For decision coaching plus evidence-based information compared with evidence-based information only (n = 7 studies), we are uncertain if decision coaching plus evidence-based information compared with evidence-based information only improves any outcomes (i.e. feeling uninformed, unclear values, feeling unsupported, knowledge, anxiety) as the certainty of the evidence was very low. AUTHORS' CONCLUSIONS Decision coaching may improve participants' knowledge when used with evidence-based information. Our findings do not indicate any significant adverse effects (e.g. decision regret, anxiety) with the use of decision coaching. It is not possible to establish strong conclusions for other outcomes. It is unclear if decision coaching always needs to be paired with evidence-informed information. Further research is needed to establish the effectiveness of decision coaching for a broader range of outcomes.
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Affiliation(s)
- Janet Jull
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Sascha Köpke
- Institute of Nursing Science, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | - Meg Carley
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Research Centre for Patient Involvement, Aarhus University & the Central Denmark Region, Aarhus, Denmark
| | - Anne C Rahn
- Institute of Social Medicine and Epidemiology, Nursing Research Unit, University of Lubeck, Lubeck, Germany
| | - Laura Boland
- Integrated Knowledge Translation Research Network, The Ottawa Hospital Research Institute, Ottawa, Canada
- Western University, London, Canada
| | - Sandra Dunn
- BORN Ontario, CHEO Research Institute, School of Nursing, University of Ottawa, Ottawa, Canada
| | - Andrew A Dwyer
- William F. Connell School of Nursing, Boston University, Chestnut Hill, Massachusetts, USA
- Munn Center for Nursing Research, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jürgen Kasper
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Simone Maria Kienlin
- Faculty of Health Sciences, Department of Health and Caring Sciences, University of Tromsø, Tromsø, Norway
- The South-Eastern Norway Regional Health Authority, Department of Medicine and Healthcare, Hamar, Norway
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, Canada
| | - Krystina B Lewis
- School of Nursing, University of Ottawa, Ottawa, Canada
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, Canada
| | | | - Claudia Rutherford
- School of Psychology, Quality of Life Office, University of Sydney, Camperdown, Australia
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Junqiang Zhao
- School of Nursing, University of Ottawa, Ottawa, Canada
| | - Tamara Rader
- Canadian Agency for Drugs and Technologies in Health (CADTH), Ottawa, Canada
| | - Ian D Graham
- Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Canada
| | - Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Canada
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12
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Witteman HO, Ndjaboue R, Vaisson G, Dansokho SC, Arnold B, Bridges JFP, Comeau S, Fagerlin A, Gavaruzzi T, Marcoux M, Pieterse A, Pignone M, Provencher T, Racine C, Regier D, Rochefort-Brihay C, Thokala P, Weernink M, White DB, Wills CE, Jansen J. Clarifying Values: An Updated and Expanded Systematic Review and Meta-Analysis. Med Decis Making 2021; 41:801-820. [PMID: 34565196 PMCID: PMC8482297 DOI: 10.1177/0272989x211037946] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Patient decision aids should help people make evidence-informed decisions aligned with their values. There is limited guidance about how to achieve such alignment. Purpose To describe the range of values clarification methods available to patient decision aid developers, synthesize evidence regarding their relative merits, and foster collection of evidence by offering researchers a proposed set of outcomes to report when evaluating the effects of values clarification methods. Data Sources MEDLINE, EMBASE, PubMed, Web of Science, the Cochrane Library, and CINAHL. Study Selection We included articles that described randomized trials of 1 or more explicit values clarification methods. From 30,648 records screened, we identified 33 articles describing trials of 43 values clarification methods. Data Extraction Two independent reviewers extracted details about each values clarification method and its evaluation. Data Synthesis Compared to control conditions or to implicit values clarification methods, explicit values clarification methods decreased the frequency of values-incongruent choices (risk difference, –0.04; 95% confidence interval [CI], –0.06 to –0.02; P < 0.001) and decisional conflict (standardized mean difference, –0.20; 95% CI, –0.29 to –0.11; P < 0.001). Multicriteria decision analysis led to more values-congruent decisions than other values clarification methods (χ2 = 9.25, P = 0.01). There were no differences between different values clarification methods regarding decisional conflict (χ2 = 6.08, P = 0.05). Limitations Some meta-analyses had high heterogeneity. We grouped values clarification methods into broad categories. Conclusions Current evidence suggests patient decision aids should include an explicit values clarification method. Developers may wish to specifically consider multicriteria decision analysis. Future evaluations of values clarification methods should report their effects on decisional conflict, decisions made, values congruence, and decisional regret.
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Affiliation(s)
- Holly O Witteman
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada.,VITAM Research Centre, Quebec City, Quebec, Canada.,CHU de Québec Research Centre, Quebec City, Quebec, Canada
| | - Ruth Ndjaboue
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada.,VITAM Research Centre, Quebec City, Quebec, Canada
| | - Gratianne Vaisson
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada.,CHU de Québec Research Centre, Quebec City, Quebec, Canada
| | - Selma Chipenda Dansokho
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Bob Arnold
- UPMC Palliative and Supportive Institute, Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, PA, USA
| | - John F P Bridges
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Sandrine Comeau
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Teresa Gavaruzzi
- Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy
| | - Melina Marcoux
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Arwen Pieterse
- Leiden University Medical Center, Leiden, The Netherlands
| | - Michael Pignone
- Departments of Internal Medicine and Population Health, Dell Medical School, University of Texas, Austin, TX, USA
| | - Thierry Provencher
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Charles Racine
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Dean Regier
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charlotte Rochefort-Brihay
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Praveen Thokala
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Douglas B White
- Program on Ethics and Decision Making in Critical Illness, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Celia E Wills
- College of Nursing, Center on Healthy Aging, Self-Management and Complex Care, The Ohio State University, Columbus, OH, USA
| | - Jesse Jansen
- Department of Family Medicine/CAPHRI, Maastricht University, Maastricht, The Netherlands
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13
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Epstein AS, Kakarala SE, Reyna VF, Saxena A, Maciejewski PK, Shah MA, Prigerson HG. Development of the Oncolo-GIST ("Giving Information Strategically & Transparently") Intervention Manual for Oncologist Skills Training in Advanced Cancer Prognostic Information Communication. J Pain Symptom Manage 2021; 62:10-19.e4. [PMID: 33253786 PMCID: PMC8155099 DOI: 10.1016/j.jpainsymman.2020.11.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 01/01/2023]
Abstract
CONTEXT Patient prognostic understanding is improved by oncologists' discussions of life expectancy. Most patients deem it important to discuss prognosis with their oncologists, but a minority of cancer patients within months of death report that they had such a discussion with their oncologist. OBJECTIVES To query stakeholders about their perspectives on the clinical approach and utility of an Oncolo-GIST manualized communication intervention, designed to enhance oncologists' ability to convey the gist of prognostic information simply, clearly, and effectively in the setting of progressing solid tumors and limited life expectancy. METHODS We obtained and analyzed feedback on the intervention from solid tumor oncology clinicians and bereaved family caregivers, soliciting opinions on the clinical approach taken in the videos, acceptability and likely impact of the instructions, and specific phrases recommended in the manual. RESULTS Twenty stakeholders (9 clinicians, 11 caregivers) participated. All agreed that oncologists should broach prognosis with patients, balancing honesty and sensitivity. Participants also advocated for oncologists to involve interprofessional team members (e.g., nurses, social workers) when serious mental health concerns arose. After the research team's discussion of the stakeholder feedback, the manual was modified to include or exclude preferred language and approaches. CONCLUSION The Oncolo-GIST intervention was characterized as simple and potentially effective at conveying prognoses to advanced cancer patients. Future research should determine if this approach to medical communication, which distills the essence of prognostic messages clearly and simply, is associated with improvements in patients' prognostic understanding.
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Affiliation(s)
- Andrew S Epstein
- Memorial Sloan Kettering Cancer Center, New York, New York, USA; Weill Cornell Medicine, New York, New York, USA.
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14
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Michael N, O'Callaghan C, Georgousopoulou E, Melia A, Sulistio M, Kissane D. Video decision support tool promoting values conversations in advanced care planning in cancer: protocol of a randomised controlled trial. BMC Palliat Care 2021; 20:95. [PMID: 34167538 PMCID: PMC8229383 DOI: 10.1186/s12904-021-00794-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 06/10/2021] [Indexed: 11/18/2022] Open
Abstract
Background Views on advance care planning (ACP) has shifted from a focus solely on treatment decisions at the end-of-life and medically orientated advanced directives to encouraging conversations on personal values and life goals, patient-caregiver communication and decision making, and family preparation. This study will evaluate the potential utility of a video decision support tool (VDST) that models values-based ACP discussions between cancer patients and their nominated caregivers to enable patients and families to achieve shared-decisions when completing ACP’s. Methods This open-label, parallel-arm, phase II randomised control trial will recruit cancer patient-caregiver dyads across a large health network. Previously used written vignettes will be converted to video vignettes using the recommended methodology. Participants will be ≥18 years and be able to complete questionnaires. Dyads will be randomised in a 1:1 ratio to a usual care (UC) or VDST group. The VDST group will watch a video of several patient-caregiver dyads communicating personal values across different cancer trajectory stages and will receive verbal and written ACP information. The UC group will receive verbal and written ACP information. Patient and caregiver data will be collected individually via an anonymous questionnaire developed for the study, pre and post the UC and VDST intervention. Our primary outcome will be ACP completion rates. Secondarily, we will compare patient-caregiver (i) attitudes towards ACP, (ii) congruence in communication, and (iii) preparation for decision-making. Conclusion We need to continue to explore innovative ways to engage cancer patients in ACP. This study will be the first VDST study to attempt to integrate values-based conversations into an ACP intervention. This pilot study’s findings will assist with further refinement of the VDST and planning for a future multisite study. Trial registration Australian New Zealand Clinical Trials Registry No: ACTRN12620001035910. Registered 12 October 2020. Retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00794-3.
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Affiliation(s)
- Natasha Michael
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, Melbourne, VIC, Australia. .,School of Medicine, Sydney Campus, University of Notre Dame Australia Darlinghurst, Darlinghurst, NSW, Australia. .,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
| | - Clare O'Callaghan
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, Melbourne, VIC, Australia.,Departments of Psychosocial Cancer Care, St Vincent's Hospital, Sydney, NSW, Australia
| | - Ekavi Georgousopoulou
- School of Medicine, Sydney Campus, University of Notre Dame Australia Darlinghurst, Darlinghurst, NSW, Australia
| | - Adelaide Melia
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, Melbourne, VIC, Australia
| | - Merlina Sulistio
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, Melbourne, VIC, Australia.,School of Medicine, Sydney Campus, University of Notre Dame Australia Darlinghurst, Darlinghurst, NSW, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - David Kissane
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, Melbourne, VIC, Australia.,School of Medicine, Sydney Campus, University of Notre Dame Australia Darlinghurst, Darlinghurst, NSW, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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15
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Nouri SS, Barnes DE, Shi Y, Volow AM, Shirsat N, Kinderman AL, Harris HA, Sudore RL. The PREPARE for Your Care program increases advance care planning engagement among diverse older adults with cancer. Cancer 2021; 127:3631-3639. [PMID: 34076892 DOI: 10.1002/cncr.33676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 04/15/2021] [Accepted: 05/03/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Advance care planning (ACP) is low among older adults with cancer. In a secondary analysis of randomized trial data, the authors compared the efficacy of the PREPARE for Your Care (PREPARE) website plus an easy-to-read advance directive (AD) with an AD only among older adults with and without cancer. METHODS Safety net, primary care patients in San Francisco were included if they were 55 years old or older, were English- or Spanish-speaking, and had 2 or more chronic conditions. The authors determined cancer diagnoses by using International Classification of Diseases, Ninth Revision/Tenth Revision codes. The primary outcome was new ACP documentation in the medical record at 15 months; the secondary outcomes were self-reported ACP engagement, ease of use, satisfaction, and depression/anxiety. The authors used mixed effects logistic and linear regression adjusted for prior ACP, health literacy, and clinician, including a cancer interaction term. RESULTS Of 986 participants, 220 (22%) had cancer. The mean age was 63 years (SD, 6 years), 61% were women, 81% were of a minority race/ethnicity, 45% were Spanish-speaking, 39% had limited health literacy, and 27% had prior ACP. New ACP documentation was higher in the PREPARE arm versus the AD-only arm among participants with cancer (62% vs 43%; P = .01) and without cancer (38% vs 28%; P = .01), as was ACP engagement in both arms (P < .001), with no interactions by cancer. Ease of use and satisfaction were high, and depression/anxiety was low, with no differences by study arm or by cancer/no cancer. CONCLUSIONS PREPARE plus an easy-to-read AD increased ACP documentation and engagement among diverse older adults with cancer more than an AD alone, with no increase in depression or anxiety between study arms or by cancer. PREPARE may help to decrease ACP disparities among patients with cancer. LAY SUMMARY Advance care planning (ACP) is the process of sharing values, goals, and preferences for medical care, but engagement in ACP is low among older adults with cancer. Among 986 English- and Spanish-speaking older adults from a safety net hospital, an interactive, multimedia, web-based ACP program (PREPARE for Your Care at https://prepareforyourcare.org/) plus an easy-to-read advance directive increased ACP documentation and engagement more than an advance directive alone. There were no differences in this increase in ACP between older adults with cancer and older adults without cancer. Also, engaging in ACP did not result in increased depression or anxiety.
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Affiliation(s)
- Sarah S Nouri
- Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Deborah E Barnes
- Department of Psychiatry, University of California San Francisco, San Francisco, California.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.,San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Ying Shi
- San Francisco Veterans Affairs Health Care System, San Francisco, California.,Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Aiesha M Volow
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Nikita Shirsat
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Anne L Kinderman
- San Francisco General Hospital and Trauma Center, San Francisco, California.,Division of Hospital Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Heather A Harris
- San Francisco General Hospital and Trauma Center, San Francisco, California.,Division of Hospital Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Rebecca L Sudore
- San Francisco Veterans Affairs Health Care System, San Francisco, California.,Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California
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16
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Bennett F, O'Conner-Von S. Communication Interventions to Improve Goal-Concordant Care of Seriously Ill Patients: An Integrative Review. J Hosp Palliat Nurs 2021; 22:40-48. [PMID: 31764395 DOI: 10.1097/njh.0000000000000606] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Effective communication between clinicians and seriously ill patients and their families about a patient's goals of care is essential to patient-centered, goal-concordant, end-of-life care. Effective goals-of-care communication between clinicians and patients is associated with improved patient and family outcomes, increased clinician satisfaction, and decreased health care costs. Unfortunately, clinicians often face barriers in goals-of-care communication and collaboration, including a lack of education, time constraints, and no standardized protocols. Without clear goals-of-care communication, patients may not be able to provide guidance to clinicians about their end-of-life preferences. The purpose of this integrative review was to examine the efficacy of goals-of-care communication interventions between patients, families, and clinicians in randomized controlled trials published between 2009 and 2018. Twenty-three studies met the inclusion criteria with an overall sample (N = 6376) of patients, family members, and clinicians. Results revealed of the 6 different intervention modes, patient decision aids and patient-clinician communication consistently increased comprehension and communication. Twelve of the studies had nurses facilitate or support the communication intervention. Because nurses are a critical, trusted nexus for communication about end-of-life care, focusing on nurse interventions may significantly improve clinical outcomes and the patient experience.
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17
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Korfage IJ, Carreras G, Arnfeldt Christensen CM, Billekens P, Bramley L, Briggs L, Bulli F, Caswell G, Červ B, van Delden JJM, Deliens L, Dunleavy L, Eecloo K, Gorini G, Groenvold M, Hammes B, Ingravallo F, Jabbarian LJ, Kars MC, Kodba-Čeh H, Lunder U, Miccinesi G, Mimić A, Ozbič P, Payne SA, Polinder S, Pollock K, Preston NJ, Seymour J, Simonič A, Thit Johnsen A, Toccafondi A, Verkissen MN, Wilcock A, Zwakman M, van der Heide A, Rietjens JAC. Advance care planning in patients with advanced cancer: A 6-country, cluster-randomised clinical trial. PLoS Med 2020; 17:e1003422. [PMID: 33186365 PMCID: PMC7665676 DOI: 10.1371/journal.pmed.1003422] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 10/19/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Advance care planning (ACP) supports individuals to define, discuss, and record goals and preferences for future medical treatment and care. Despite being internationally recommended, randomised clinical trials of ACP in patients with advanced cancer are scarce. METHODS AND FINDINGS To test the implementation of ACP in patients with advanced cancer, we conducted a cluster-randomised trial in 23 hospitals across Belgium, Denmark, Italy, Netherlands, Slovenia, and United Kingdom in 2015-2018. Patients with advanced lung (stage III/IV) or colorectal (stage IV) cancer, WHO performance status 0-3, and at least 3 months life expectancy were eligible. The ACTION Respecting Choices ACP intervention as offered to patients in the intervention arm included scripted ACP conversations between patients, family members, and certified facilitators; standardised leaflets; and standardised advance directives. Control patients received care as usual. Main outcome measures were quality of life (operationalised as European Organisation for Research and Treatment of Cancer [EORTC] emotional functioning) and symptoms. Secondary outcomes were coping, patient satisfaction, shared decision-making, patient involvement in decision-making, inclusion of advance directives (ADs) in hospital files, and use of hospital care. In all, 1,117 patients were included (442 intervention; 675 control), and 809 (72%) completed the 12-week questionnaire. Patients' age ranged from 18 to 91 years, with a mean of 66; 39% were female. The mean number of ACP conversations per patient was 1.3. Fidelity was 86%. Sixteen percent of patients found ACP conversations distressing. Mean change in patients' quality of life did not differ between intervention and control groups (T-score -1.8 versus -0.8, p = 0.59), nor did changes in symptoms, coping, patient satisfaction, and shared decision-making. Specialist palliative care (37% versus 27%, p = 0.002) and AD inclusion in hospital files (10% versus 3%, p < 0.001) were more likely in the intervention group. A key limitation of the study is that recruitment rates were lower in intervention than in control hospitals. CONCLUSIONS Our results show that quality of life effects were not different between patients who had ACP conversations and those who received usual care. The increased use of specialist palliative care and AD inclusion in hospital files of intervention patients is meaningful and requires further study. Our findings suggest that alternative approaches to support patient-centred end-of-life care in this population are needed. TRIAL REGISTRATION ISRCTN registry ISRCTN63110516.
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Affiliation(s)
- Ida J. Korfage
- Department of Public Health, Erasmus MC, Rotterdam, Netherlands
- * E-mail:
| | - Giulia Carreras
- Clinical Epidemiology, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Caroline M. Arnfeldt Christensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Palliative Medicine, Research Unit, Bispebjerg Hospital, Copenhagen, Denmark
| | | | - Louise Bramley
- Institute of Nursing and Midwifery Care Excellence, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Linda Briggs
- Respecting Choices, C-TAC Innovations, Oregon, Wisconsin, United States of America
| | - Francesco Bulli
- Clinical Epidemiology, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Glenys Caswell
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Branka Červ
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | | | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium
| | - Lesley Dunleavy
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, United Kingdom
| | - Kim Eecloo
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium
| | - Giuseppe Gorini
- Clinical Epidemiology, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Mogens Groenvold
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Palliative Medicine, Research Unit, Bispebjerg Hospital, Copenhagen, Denmark
| | - Bud Hammes
- Respecting Choices, C-TAC Innovations, Oregon, Wisconsin, United States of America
| | - Francesca Ingravallo
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | | | - Marijke C. Kars
- Julius Centre for Health Sciences and Primary Care, UMC Utrecht, Utrecht, Netherlands
| | - Hana Kodba-Čeh
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Urska Lunder
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Guido Miccinesi
- Clinical Epidemiology, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Alenka Mimić
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Polona Ozbič
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Sheila A. Payne
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, United Kingdom
| | | | - Kristian Pollock
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Nancy J. Preston
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, United Kingdom
| | - Jane Seymour
- Health Sciences School, University of Sheffield, Sheffield, United Kingdom
| | - Anja Simonič
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Anna Thit Johnsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Palliative Medicine, Research Unit, Bispebjerg Hospital, Copenhagen, Denmark
| | - Alessandro Toccafondi
- Clinical Epidemiology, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Mariëtte N. Verkissen
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium
| | - Andrew Wilcock
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Marieke Zwakman
- Julius Centre for Health Sciences and Primary Care, UMC Utrecht, Utrecht, Netherlands
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18
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Agarwal R, Shuk E, Romano D, Genoff M, Li Y, O’Reilly EM, Breitbart W, Volandes AE, Epstein AS. A mixed methods analysis of patients' advance care planning values in outpatient oncology: Person-Centered Oncologic Care and Choices (P-COCC). Support Care Cancer 2020; 28:1109-1119. [PMID: 31197540 PMCID: PMC6908761 DOI: 10.1007/s00520-019-04910-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 05/31/2019] [Indexed: 01/02/2023]
Abstract
PURPOSE Person-Centered Oncologic Care and Choices (P-COCC) combines an advance care planning (ACP) value-focused patient interview with a care goal video decision aid. Our randomized study showed that P-COCC was acceptable but increased participant distress, compared with video-alone and usual care study arms. This mixed methods approach explores the ACP values in the P-COCC arm and their relationship to the distress phenomenon. METHODS Qualitative thematic analysis of the 46 audio-recorded P-COCC interview transcripts with advanced gastrointestinal cancer patients was performed by multiple reviewers. Quantitative (Likert scale) changes in ACP values were compared across study arms. ACP themes and value change were analyzed in participants with increased distress. RESULTS Transcript analysis resulted in thematic saturation and identified eight distinct themes on ACP values relating to end-of-life wishes, communication needs, and psychosocial supports. Of 98 participants (33 P-COCC, 43 videos, 22 usual care) who completed the change in value measure, there was no difference detected with P-COCC compared with either video (p = 0.052) or usual care (p = 0.105) arms alone, but P-COCC led to a frequency distribution of more change in personal values compared with the other study arms combined (p = 0.043). Among the subset of P-COCC participants with increased distress, there was no statistical relationship with change in values. CONCLUSIONS The ACP paradigm P-COCC both informs and supports patients in individualized, value-based decision-making. Distress is not associated with changes in ACP values and may be a necessary, at least transient, byproduct of discussing sensitive but pertinent topics about end-of-life medical care.
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Affiliation(s)
- Rajiv Agarwal
- Memorial Sloan Kettering Cancer Center, 300 E. 66th Street, Room 1013, New York, NY 10065, USA
| | - Elyse Shuk
- Memorial Sloan Kettering Cancer Center, 300 E. 66th Street, Room 1013, New York, NY 10065, USA
| | - Danielle Romano
- Memorial Sloan Kettering Cancer Center, 300 E. 66th Street, Room 1013, New York, NY 10065, USA
| | - Margaux Genoff
- Memorial Sloan Kettering Cancer Center, 300 E. 66th Street, Room 1013, New York, NY 10065, USA
| | - Yuelin Li
- Memorial Sloan Kettering Cancer Center, 300 E. 66th Street, Room 1013, New York, NY 10065, USA
| | - Eileen M. O’Reilly
- Memorial Sloan Kettering Cancer Center, 300 E. 66th Street, Room 1013, New York, NY 10065, USA,Weill Cornell Medical College, New York, NY, USA
| | - William Breitbart
- Memorial Sloan Kettering Cancer Center, 300 E. 66th Street, Room 1013, New York, NY 10065, USA,Weill Cornell Medical College, New York, NY, USA
| | | | - Andrew S. Epstein
- Memorial Sloan Kettering Cancer Center, 300 E. 66th Street, Room 1013, New York, NY 10065, USA,Weill Cornell Medical College, New York, NY, USA
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19
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Epstein AS, Desai AV, Bernal C, Romano D, Wan PJ, Okpako M, Anderson K, Chow K, Kramer D, Calderon C, Klimek VV, Rawlins-Duell R, Reidy DL, Goldberg JI, Cruz E, Nelson JE. Giving Voice to Patient Values Throughout Cancer: A Novel Nurse-Led Intervention. J Pain Symptom Manage 2019; 58:72-79.e2. [PMID: 31034869 PMCID: PMC6849206 DOI: 10.1016/j.jpainsymman.2019.04.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/18/2019] [Accepted: 04/19/2019] [Indexed: 12/22/2022]
Abstract
CONTEXT Optimal advance care planning allows patients to articulate their values as a touchstone for medical decision making. Ideally, this occurs when patients are clinically stable, and with opportunities for iteration as the clinical situation unfolds. OBJECTIVES Testing feasibility and acceptability in busy outpatient oncology clinics of a novel program of systematic, oncology nurse-led values discussions with all new cancer patients. METHODS Within an institutional initiative integrating primary and specialist palliative care from diagnosis for all cancer patients, oncology nurses were trained to use specific questions and an empathic communication framework to discuss health-related values during outpatient clinic visits. Nurses summarized discussions on a template for patient verification, oncologist review, and electronic medical record documentation. Summaries were reviewed with the patient at least quarterly. Feasibility and acceptability were evaluated in three clinics for patients with hematologic or gastrointestinal malignancies. RESULTS Oncology nurses conducted 177 total discussions with 67 newly diagnosed cancer patients (17 with hematologic and 50 with gastrointestinal malignancies) over two years. No patient declined participation. Discussions averaged eight minutes, and all patients verified values summaries. Clinic patient volume was maintained. Of 31 patients surveyed, 30 (97%) reported feeling comfortable with the process, considered it helpful, and would recommend it to others. Clinicians strongly endorsed the values discussion process. CONCLUSION Nurse-led discussions of patient values soon after diagnosis are feasible and acceptable in busy oncology clinics. Further research will evaluate the impact of this novel approach on additional patient-oriented outcomes after broader dissemination of this initiative throughout our institution.
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Affiliation(s)
- Andrew S Epstein
- Memorial Sloan Kettering Cancer Center, New York, New York, USA; Weill Cornell Medical College, New York, New York, USA.
| | - Anjali V Desai
- Memorial Sloan Kettering Cancer Center, New York, New York, USA; Weill Cornell Medical College, New York, New York, USA
| | - Camila Bernal
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Danielle Romano
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Peter J Wan
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Molly Okpako
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kelly Anderson
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kimberly Chow
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Dana Kramer
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Virginia V Klimek
- Memorial Sloan Kettering Cancer Center, New York, New York, USA; Weill Cornell Medical College, New York, New York, USA
| | | | - Diane L Reidy
- Memorial Sloan Kettering Cancer Center, New York, New York, USA; Weill Cornell Medical College, New York, New York, USA
| | | | - Elizabeth Cruz
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Judith E Nelson
- Memorial Sloan Kettering Cancer Center, New York, New York, USA; Weill Cornell Medical College, New York, New York, USA
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20
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Communication involving special populations: older adults with cancer. Curr Opin Support Palliat Care 2019; 13:64-68. [DOI: 10.1097/spc.0000000000000408] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Levoy K, Salani DA, Buck H. A Systematic Review and Gap Analysis of Advance Care Planning Intervention Components and Outcomes Among Cancer Patients Using the Transtheoretical Model of Health Behavior Change. J Pain Symptom Manage 2019; 57:118-139.e6. [PMID: 30595148 DOI: 10.1016/j.jpainsymman.2018.10.502] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/19/2018] [Accepted: 10/19/2018] [Indexed: 12/11/2022]
Abstract
CONTEXT Despite the benefits of advance care planning (ACP), cancer patients rarely engage in ACP. ACP is a process that parallels health behavior change. This makes the Transtheoretical Model of Health Behavior Change (TTM) an important framework for understanding how to increase ACP among cancer patients. OBJECTIVES This study aimed to systematically review ACP interventions for cancer patients by 1) categorizing ACP intervention components according to the stages and processes of behavior change in the TTM, 2) conducting a gap analysis among the categorized components, and 3) identifying patterns between the categorized intervention components and the intervention outcomes. METHODS PubMed, CINAHL Plus, MEDLINE, Cochrane Library, and Web of Science databases were searched for articles related to ACP and cancer. ACP intervention components were abstracted, assessed for theoretical relevance, organized according to the stages and process of change in the TTM, and then synthesized. RESULTS The search produced 4604 articles, with 25 meeting criteria for review. Most intervention components targeted the precontemplation and contemplation stages of change, with fewer targeting preparation, action, or maintenance. Multiple processes of change were not addressed. Interventions that resulted in ACP engagement tended to take an interdisciplinary approach to implementation and consisted of multiple consultations staged over time. CONCLUSION ACP likely requires "high touch" interventions to induce behavior change. ACP interventions that are stage-matched, use diverse mechanisms to engage ACP (i.e., processes of change), address ACP as a process, and monitor engagement across the illness trajectory are needed for cancers patients and their caregivers.
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Affiliation(s)
- Kristin Levoy
- University of Miami School of Nursing and Health Studies, Coral Gables, Florida, USA.
| | - Deborah A Salani
- University of Miami School of Nursing and Health Studies, Coral Gables, Florida, USA
| | - Harleah Buck
- University of South Florida College of Nursing, Tampa, Florida, USA
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