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Mat Lazim NH, Syed A, Lee C, Ahmed Abousheishaa A, Chong Guan N. Using decision support tools for treatment decision making about antidepressants in outpatient psychiatric consultations. PATIENT EDUCATION AND COUNSELING 2024; 124:108266. [PMID: 38565074 DOI: 10.1016/j.pec.2024.108266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 03/11/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To examine the use of decision support tools in decision making about antidepressants during conversations between patients with major depressive disorder (MDD) and their psychiatrists. METHODS Theme-oriented discourse analysis of two psychiatric consultation groups: control (n = 17) and intervention (n = 16). In the control group, only a doctor's conversation guide was used; in the intervention group, the conversation guide and a patient decision aid (PDA) were used. RESULTS Psychiatrists mainly dominated conversations in both consultation groups. They were less likely to elicit patient treatment-related perspectives in the intervention group as they focused more on delivering the information than obtaining patient perspectives. However, using PDA in the intervention group slightly encouraged patients to participate in decisional talk. CONCLUSION The decision support tools did promote SDM performance. Using the conversation guide in both consultation groups encouraged the elicitation of patient perspectives, which helped the psychiatrists in tailoring their recommendations of options based on patient preferences and concerns. Using the PDA in the intervention group created space for treatment discussion and fostered active collaboration in treatment decision making. PRACTICE IMPLICATIONS Our findings have implications for SDM communication skills training and critical reflection on SDM practice.
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Affiliation(s)
- Nor Hazila Mat Lazim
- Department of English Language, Faculty of Languages and Linguistics, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ayeshah Syed
- Department of English Language, Faculty of Languages and Linguistics, Universiti Malaya, Kuala Lumpur, Malaysia.
| | - Charity Lee
- Department of Asian and European Languages, Faculty of Languages and Linguistics, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Aya Ahmed Abousheishaa
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ng Chong Guan
- Department of Psychological Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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Tate A, Spencer KL. High-Stakes Treatment Negotiations Gone Awry: The Importance of Interactions for Understanding Treatment Advocacy and Patient Resistance. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2024; 65:237-255. [PMID: 37905523 PMCID: PMC11058117 DOI: 10.1177/00221465231204354] [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] [Indexed: 11/02/2023]
Abstract
Doctors (and sociologists) have a long history of struggling to understand why patients seek medical help yet resist treatment recommendations. Explanations for resistance have pointed to macrostructural changes, such as the rise of the engaged patient or decline of physician authority. Rather than assuming that concepts such as resistance, authority, or engagement are exogenous phenomena transmitted via conversational conduits, we examine how they are dynamically co-constituted interactionally. Using conversation analysis to analyze a videotaped interaction of an oncology patient resisting the treatment recommendation even though she might die without treatment, we show how sustained resistance manifests in and through her doctor's actions. This paradox, in which the doctor can both recommend life-prolonging care and condition resistance to it, has broad relevance beyond cancer treatment; it also can help us to understand other doctor-patient decisional conflicts, for instance, medication nonadherence, delaying emergent care, and vaccine refusal.
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Canavan ME, Wang X, Ascha MS, Miksad RA, Showalter TN, Calip GS, Gross CP, Adelson KB. Systemic Anticancer Therapy and Overall Survival in Patients With Very Advanced Solid Tumors. JAMA Oncol 2024:2818763. [PMID: 38753341 PMCID: PMC11099840 DOI: 10.1001/jamaoncol.2024.1129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/20/2023] [Indexed: 05/19/2024]
Abstract
Importance Two prominent organizations, the American Society of Clinical Oncology and the National Quality Forum (NQF), have developed a cancer quality metric aimed at reducing systemic anticancer therapy administration at the end of life. This metric, NQF 0210 (patients receiving chemotherapy in the last 14 days of life), has been critiqued for focusing only on care for decedents and not including the broader population of patients who may benefit from treatment. Objective To evaluate whether the overall population of patients with metastatic cancer receiving care at practices with higher rates of oncologic therapy for very advanced disease experience longer survival. Design, Setting, and Participants This nationwide population-based cohort study used Flatiron Health, a deidentified electronic health record database of patients diagnosed with metastatic or advanced disease, to identify adult patients (aged ≥18 years) with 1 of 6 common cancers (breast cancer, colorectal cancer, non-small cell lung cancer [NSCLC], pancreatic cancer, renal cell carcinoma, and urothelial cancer) treated at health care practices from 2015 to 2019. Practices were stratified into quintiles based on retrospectively measured rates of NQF 0210, and overall survival was compared by disease type among all patients treated in each practice quintile from time of metastatic diagnosis using multivariable Cox proportional hazard models with a Bonferroni correction for multiple comparisons. Data were analyzed from July 2021 to July 2023. Exposure Practice-level NQF 0210 quintiles. Main Outcome and Measure Overall survival. Results Of 78 446 patients (mean [SD] age, 67.3 [11.1] years; 52.2% female) across 144 practices, the most common cancer types were NSCLC (34 201 patients [43.6%]) and colorectal cancer (15 804 patients [20.1%]). Practice-level NQF 0210 rates varied from 10.9% (quintile 1) to 32.3% (quintile 5) for NSCLC and 6.8% (quintile 1) to 28.4% (quintile 5) for colorectal cancer. No statistically significant differences in survival were observed between patients treated at the highest and the lowest NQF 0210 quintiles. Compared with patients seen at practices in the lowest NQF 0210 quintiles, the hazard ratio for death among patients seen at the highest quintiles varied from 0.74 (95% CI, 0.55-0.99) for those with renal cell carcinoma to 1.41 (95% CI, 0.98-2.02) for those with urothelial cancer. These differences were not statistically significant after applying the Bonferroni-adjusted critical P = .008. Conclusions and Relevance In this cohort study, patients with metastatic or advanced cancer treated at practices with higher NQF 0210 rates did not have improved survival. Future efforts should focus on helping oncologists identify when additional therapy is futile, developing goals of care communication skills, and aligning payment incentives with improved end-of-life care.
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Affiliation(s)
- Maureen E. Canavan
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Connecticut
| | | | | | - Rebecca A. Miksad
- Flatiron Health, New York, New York
- Department of Hematology and Oncology, Boston Medical Center, Boston, Massachusetts
| | | | - Gregory S. Calip
- Flatiron Health, New York, New York
- Program on Medicines and Public Health, Titus Family Department of Clinical Pharmacy, University of Southern California School of Pharmacy, Los Angeles
| | - Cary P. Gross
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Connecticut
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Singh S, Dafoe A, Lahoff D, Tropeano L, Owens B, Nielsen E, Cagle J, Lum HD, Dorsey Holliman B, Fischer S. A Process Evaluation of a Palliative Care Social Work Intervention for Cancer Patients in Skilled Nursing Facilities. J Palliat Med 2024. [PMID: 38563805 DOI: 10.1089/jpm.2023.0381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Background: Assessing and Listening to Individual Goals and Needs (ALIGN) is a palliative care social work intervention that aims to improve delivery of goal-concordant care for hospitalized older adults with cancer discharged to skilled nursing facilities. Objective: Explore processes through which ALIGN may improve delivery of goal-concordant care to substantiate the conceptual model grounding the intervention and to inform mechanistic hypotheses of how the intervention might be effective. Design: A process evaluation triangulating findings from patient and caregiver interviews with a matrix analysis of ALIGN social worker notes. Setting/Participants: Patients (n = 6) and caregivers (n = 13) who participated in a single-arm pilot study of ALIGN in the United States and 113 intervention notes (n = 18 patients) written by 2 ALIGN social workers. Measurement: Qualitative thematic content analysis Results: Themes included the following: (1) ALIGN helped reconcile participants' misaligned expectations of rehabilitation with the reality of the patient's progressive illness; (2) ALIGN helped participants manage uncertainty and stress about forthcoming medical decision making; (3) the longitudinal nature of ALIGN allowed for iterative value-based goals of care discussions during a time when patients were changing their focus of treatment; and (4) ALIGN activated participants to advocate for their needs. Conclusions: ALIGN offers support in prognostic understanding, communication, and decision making during a pivotal time when patient and caregivers' goals have not been met and they are reassessing priorities. A larger trial is needed to understand how these processes may improve the ability of participants to make value-based decisions and aide in delivery of goal-concordant care. Clinical Trial Registration Number: NCT04882111.
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Affiliation(s)
- Sarguni Singh
- Division of Hospital Medicine, University of Colorado Denver, Aurora, Colorado, USA
| | - Ashley Dafoe
- Adult and Child Center for Outcomes Research and Delivery Science, Aurora, Colorado, USA
| | | | | | - Bree Owens
- The Holding Group, Denver, Colorado, USA
| | | | - John Cagle
- University of Maryland School of Social Work, Baltimore, Maryland, USA
| | - Hillary D Lum
- Division of Geriatric Medicine, University of Colorado Denver, Aurora, Colorado, USA
| | - Brooke Dorsey Holliman
- Adult and Child Center for Outcomes Research and Delivery Science, Aurora, Colorado, USA
| | - Stacy Fischer
- Division of General Internal Medicine, University of Colorado Denver, Aurora, Colorado, USA
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Pino M, Jenkins L. Inviting the Patient to Talk About a Conversation They Had with Another Healthcare Practitioner: A Way of Promoting Discussion About Disease Progression and End of Life in Palliative Care Interactions. HEALTH COMMUNICATION 2024; 39:778-792. [PMID: 36908097 DOI: 10.1080/10410236.2023.2185579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Discussing disease progression is a core task in palliative care. This is especially important when there are indications that a patient considers their death as less imminent than the clinical team does. This article examines a communicative action that palliative medicine doctors use to address such discrepancies in knowledge and understanding of the patient's prognosis: inviting the patient to talk about the contents of a conversation they had with another healthcare practitioner. The study used conversation analysis to examine five consultations in which this action was identified. These were part of a larger data set of 37 consultations recorded in a large UK hospice and involving patients with palliative care needs, sometimes accompanied by family or friends, and palliative medicine doctors. Findings are that the action of inviting the patient to talk about a previous conversation creates an opportunity for patients to articulate what they know and understand about their disease progression - but without requiring them to do so. Discussing such sensitive matters is thus made a matter of 'opting in' (rather than 'opting out'). Doctors thereby avoid being interactionally accountable for directly initiating a potentially distressing topic. The article shows how the task of discussing disease progression and end of life is intertwined with the delicate management of patients' displayed states of awareness regarding their disease progression. The study thus has practical implications by documenting ways in which clinicians can help patients realign their expectations about such delicate matters.
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Affiliation(s)
- Marco Pino
- School of Social Sciences and Humanities, Loughborough University
| | - Laura Jenkins
- School of Social Sciences and Humanities, Loughborough University
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Nahm SH, Subramaniam S, Stockler MR, Kiely BE. Timing of prognostic discussions in people with advanced cancer: a systematic review. Support Care Cancer 2024; 32:127. [PMID: 38261070 DOI: 10.1007/s00520-023-08230-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 12/03/2023] [Indexed: 01/24/2024]
Abstract
PURPOSE Many people with cancer (patients) want to know their prognosis (a quantitative estimate of their life expectancy) but this is often not discussed or poorly communicated. The optimal timing of prognostic discussions with people with advanced cancer is highly personalised and complex. We aimed to find, organise, and summarise research regarding the timing of discussions of prognosis with people with advanced cancer. METHODS We conducted a systematic review of publications from databases, clinical practice guidelines, and grey literature from inception to 2023. We also searched the reference lists of systematic reviews, editorials, and clinical trial registries. Eligibility criteria included publications regarding adults with advanced cancer that reported a timepoint when a discussion of prognosis occurred or should occur. RESULTS We included 63 of 798 identified references; most of which were cross-sectional cohort studies with a range of 4-9105 participants. Doctors and patients agreed on several timepoints including at diagnosis of advanced cancer, when the patient asked, upon disease progression, when there were no further anti-cancer treatments, and when recommending palliative care. Most of these timepoints aligned with published guidelines and expert recommendations. Other recommended timepoints depended on the doctor's clinical judgement, such as when the patient 'needed to know' or when the patient 'seemed ready'. CONCLUSIONS Prognostic discussions with people with advanced cancer need to be individualised, and there are several key timepoints when doctors should attempt to initiate these conversations. These recommended timepoints can inform clinical trial design and communication training for doctors to help improve prognostic understanding.
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Affiliation(s)
- Sharon H Nahm
- The NHMRC Clinical Trials Centre, The University of Sydney, Locked Bag 77, Camperdown, Sydney, NSW, 1450, Australia
- Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Shalini Subramaniam
- The NHMRC Clinical Trials Centre, The University of Sydney, Locked Bag 77, Camperdown, Sydney, NSW, 1450, Australia
- Bankstown Cancer Centre, Sydney, Australia
| | - Martin R Stockler
- The NHMRC Clinical Trials Centre, The University of Sydney, Locked Bag 77, Camperdown, Sydney, NSW, 1450, Australia
- Concord Cancer Centre, Sydney, Australia
| | - Belinda E Kiely
- The NHMRC Clinical Trials Centre, The University of Sydney, Locked Bag 77, Camperdown, Sydney, NSW, 1450, Australia.
- Concord Cancer Centre, Sydney, Australia.
- Macarthur Cancer Therapy Centre, Sydney, Australia.
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Prsic E, Morris JC, Adelson KB, Parker NA, Gombos EA, Kottarathara MJ, Novosel M, Castillo L, Gould Rothberg BE. Oncology hospitalist impact on hospice utilization. Cancer 2023; 129:3797-3804. [PMID: 37706601 DOI: 10.1002/cncr.35008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/02/2023] [Accepted: 07/15/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Unplanned hospitalizations among patients with advanced cancer are often sentinel events prompting goals of care discussions and hospice transitions. Late referrals to hospice, especially those at the end of life, are associated with decreased quality of life and higher total health care costs. Inpatient management of patients with solid tumor malignancies is increasingly shifting from oncologists to oncology hospitalists. However, little is known about the impact of oncology hospitalists on the timing of transition to hospice. OBJECTIVE To compare hospice discharge rate and time to hospice discharge on an inpatient oncology service led by internal medicine-trained hospitalists and a service led by oncologists. METHODS At Smilow Cancer Hospital, internal medicine-trained hospitalists were integrated into one of two inpatient medical oncology services allowing comparison between the new, hospitalist-led service (HS) and the traditional, oncologist-led service (TS). Discharges from July 26, 2021, through January 31, 2022, were identified from the electronic medical record. The odds ratio for discharge disposition by team was calculated by logistic regression using a multinomial distribution. Adjusted length of stay before discharge was assessed using multivariable linear regression. RESULTS The HS discharged 47/400 (11.8%) patients to inpatient hospice, whereas the TS service discharged 18/313 (5.8%), yielding an adjusted odds ratio of 1.94 (95% CI, 1.07-3.51; p = .03). Adjusted average length of stay before inpatient hospice disposition was 6.83 days (95% CI, 4.22-11.06) for the HS and 16.29 days (95% CI, 7.73-34.29) for the TS (p = .003). CONCLUSIONS Oncology hospitalists improve hospice utilization and time to inpatient hospice referral on an inpatient medical oncology service. PLAIN LANGUAGE SUMMARY Patients with advanced cancer are often admitted to the hospital near the end of life. These patients generally have a poor chance of long-term survival and may prefer comfort-focused care with hospice. In this study, oncology hospitalists discharged a higher proportion of patients to inpatient hospice with less time spent in the hospital before discharge.
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Affiliation(s)
- Elizabeth Prsic
- Section of Medical Oncology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jensa C Morris
- Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Hospital Medicine Service, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Kerin B Adelson
- Section of Medical Oncology, Yale School of Medicine, New Haven, Connecticut, USA
- Yale University Yale Cancer Center, New Haven, Connecticut, USA
| | - Nathaniel A Parker
- Section of Medical Oncology, Yale School of Medicine, New Haven, Connecticut, USA
- Hospital Medicine Service, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Erin A Gombos
- Section of Medical Oncology, Yale School of Medicine, New Haven, Connecticut, USA
- Hospital Medicine Service, Yale New Haven Hospital, New Haven, Connecticut, USA
| | | | - Madison Novosel
- Yale University School of Public Health, New Haven, Connecticut, USA
| | - Lawrence Castillo
- Yale University School of Public Health, New Haven, Connecticut, USA
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Carlisle EM, Shinkunas LA, Lieberman MT, Hoffman RM, Reisinger HS. Evaluation of a Novel Question Prompt List in Pediatric Surgical Oncology. J Surg Res 2023; 292:44-52. [PMID: 37579715 PMCID: PMC10592310 DOI: 10.1016/j.jss.2023.07.029] [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: 02/28/2023] [Revised: 05/25/2023] [Accepted: 07/12/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Parents of children with cancer describe interactions with clinicians as emotionally distressing. Patient engagement in treatment discussions decreases decisional conflict and improves decision quality which may limit such distress. We have shown that parents prefer to engage surgeons by asking questions, but parents may not know what to ask. Question Prompt Lists (QPLs), structured lists of questions designed to help patients ask important questions, have not been studied in pediatric surgery. We developed a QPL designed to empower parents to ask meaningful questions during pediatric surgical oncology discussions. We conducted a mixed methods analysis to assess the acceptability, appropriateness, and feasibility of using the QPL. METHODS Key stakeholders at an academic children's hospital participated in focus groups to discuss the QPL. Focus groups were recorded and transcribed. Participants were surveyed regarding QPL acceptability, appropriateness, and feasibility. Thematic content analysis of transcripts was performed. RESULTS Four parents, five nurses, five nurse practitioners, five oncologists, and four surgeons participated. Seven key themes were identified: (1) QPL as a tool of empowerment; (2) stick to the surgical details; (3) QPLs can impact discussion quality; (4) time consuming, but not overly disruptive; (5) parental emotion may impact QPL use; (6) provide QPLs prior to surgical consultation in both print and digital formats; and (7) expansion of QPLs to other disciplines. Over 70% of participants agreed that the QPL was acceptable, appropriate, and feasible. CONCLUSIONS Our novel QPL is acceptable, appropriate, and feasible to use with parents of pediatric surgical oncology patients.
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Affiliation(s)
- Erica M Carlisle
- Division of Pediatric Surgery, Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa; Program in Bioethics and Humanities, University of Iowa Carver College of Medicine, Iowa City, Iowa.
| | - Laura A Shinkunas
- Program in Bioethics and Humanities, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | | | - Richard M Hoffman
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Heather Schacht Reisinger
- Program in Bioethics and Humanities, University of Iowa Carver College of Medicine, Iowa City, Iowa; Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa; Institute for Clinical and Translational Science, University of Iowa, Iowa City, Iowa
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Ufere NN, El-Jawahri A, Ritchie C, Lai JC, Schwarze ML. Promoting Prognostic Understanding and Health Equity for Patients With Advanced Liver Disease: Using "Best Case/Worst Case". Gastroenterology 2023; 164:171-176. [PMID: 36702571 DOI: 10.1053/j.gastro.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Nneka N Ufere
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, and, Harvard Medical School, Boston, Massachusetts, and, The Mongan Institute, Boston, Massachusetts
| | - Areej El-Jawahri
- Harvard Medical School, Boston, Massachusetts, and, The Mongan Institute, Boston, Massachusetts, and, Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christine Ritchie
- Harvard Medical School, Boston, Massachusetts, and, The Mongan Institute, Boston, Massachusetts, and, Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Jennifer C Lai
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California
| | - Margaret L Schwarze
- Division of Vascular Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Promoting Prognostic Understanding and Health Equity for Patients With Advanced Liver Disease: Using "Best Case/Worst Case". Clin Gastroenterol Hepatol 2023; 21:250-255. [PMID: 36697145 DOI: 10.1016/j.cgh.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Indexed: 01/27/2023]
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Singh S, Dafoe A, Lahoff D, Tropeano L, Owens B, Nielsen E, Cagle J, Lum HD, Dorsey Holliman B, Fischer S. Pilot Trial of a Social Work Intervention to Provide Palliative Care for Adults with Cancer in Skilled Nursing Facilities. J Palliat Med 2022; 26:527-538. [PMID: 36409676 DOI: 10.1089/jpm.2022.0413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Hospitalized patients with cancer and their caregivers discharged to skilled nursing facilities (SNFs) have unmet palliative care needs. Objective: To determine feasibility and acceptability of Assessing and Listening to Individual Goals and Needs (ALIGN), a palliative care social worker (PCSW) intervention, for older adults and their caregivers in SNFs. Design: Single-arm, single-site pilot study. Predefined feasibility goals were >70% intervention completion and study retention rates (postintervention outcomes completed at one week). Setting/Subjects: Twenty-three patients with cancer and their 21 caregivers discharged to 12 SNFs posthospitalization. Measurements: Primary outcomes were feasibility and acceptability. Exploratory patient and caregiver-reported outcomes, including goals of care were collected at baseline and one week postintervention. Health care utilization, mortality, and hospice utilization was collected at the six-month follow-up. Results: Of 73 patients screened, 35 (48%) were eligible and 23 (66%) patients and 21 caregivers enrolled. Eighteen (78%) patients completed the intervention and 10 (44%) patients and 13 (62%) caregivers provided follow-up outcomes. Average age of patients was 73, and 19 (83%) had stage III or IV cancer. Average age of caregivers was 55. Eight (44%) patients' preferences changed to prefer less aggressive care. Nineteen (83%) patients died during or shortly after intervention completion. Qualitative feedback from participant and SNF staff interviews supported high acceptability. PCSW involvement increased illness understanding and patient engagement with advance care planning. SNF staff valued increased palliative support. Conclusions: Intervention completion was >70%, however, not study retention due to higher-than-expected mortality. Future study should account for high mortality and examine whether ALIGN can better prepare surrogate decision makers and enhance the ability of SNFs to address changing goals of care. Clinical Trial Registration Number NCT04882111.
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Affiliation(s)
- Sarguni Singh
- Division of Hospital Medicine, University of Colorado Denver, Aurora, Colorado, USA
| | - Ashley Dafoe
- Adult and Child Center for Outcomes Research and Delivery Science, Aurora, Colorado, USA
| | | | | | - Bree Owens
- The Holding Group, Denver, Colorado, USA
| | | | - John Cagle
- University of Maryland School of Social Work, Baltimore, Maryland, USA
| | - Hillary D. Lum
- Division of Geriatric Medicine, University of Colorado Denver, Aurora, Colorado, USA
| | - Brooke Dorsey Holliman
- Adult and Child Center for Outcomes Research and Delivery Science, Aurora, Colorado, USA
| | - Stacy Fischer
- Division of General Internal Medicine, University of Colorado Denver, Aurora, Colorado, USA
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Petrillo LA, Shimer SE, Zhou AZ, Sommer RK, Feldman JE, Hsu KE, Greer JA, Traeger LN, Temel JS. Prognostic communication about lung cancer in the precision oncology era: A multiple-perspective qualitative study. Cancer 2022; 128:3120-3128. [PMID: 35731234 DOI: 10.1002/cncr.34369] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/31/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although most patients with cancer prefer to know their prognosis, prognostic communication between oncologists and patients is often insufficient. Targeted therapies for lung cancer improve survival yet are not curative and produce variable responses. This study sought to describe how oncologists communicate about prognosis with patients receiving targeted therapies for lung cancer. METHODS This qualitative study included 39 patients with advanced lung cancer with targetable mutations, 14 caregivers, and 10 oncologists. Semistructured interviews with patients and caregivers and focus groups or interviews with oncologists were conducted to explore their experiences with prognostic communication. One oncology follow-up visit was audio-recorded per patient. A framework approach was used to analyze interview transcripts, and a content analysis of patient-oncologist dialogue was conducted. Themes were identified within each source and then integrated across sources to create a multidimensional description of prognostic communication. RESULTS Six themes in prognostic communication were identified: Patients with targetable mutations develop a distinct identity in the lung cancer community that affects their information-seeking and self-advocacy; oncologists set high expectations for targeted therapy; the uncertain availability of new therapies complicates prognostic discussions; patients and caregivers have variable information preferences; patients raise questions about progression by asking about physical symptoms or scan results; and patients' expectations of targeted therapy influence their medical decision-making. CONCLUSIONS Optimistic patient-oncologist communication shapes the expectations of patients receiving targeted therapy for lung cancer and affects their decision-making. Further research and clinical guidance are needed to help oncologists to communicate uncertain outcomes effectively.
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Affiliation(s)
- Laura A Petrillo
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sophia E Shimer
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ashley Z Zhou
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Robert K Sommer
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Kelly E Hsu
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joseph A Greer
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lara N Traeger
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jennifer S Temel
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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LeBaron V, Boukhechba M, Edwards J, Flickinger T, Ling D, Barnes LE. Exploring the use of wearable sensors and natural language processing technology to improve patient-clinician communication: Protocol for a feasibility study (Preprint). JMIR Res Protoc 2022; 11:e37975. [PMID: 35594139 PMCID: PMC9166632 DOI: 10.2196/37975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 03/24/2022] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Virginia LeBaron
- School of Nursing, University of Virginia, Charlottesville, VA, United States
| | - Mehdi Boukhechba
- School of Engineering & Applied Science, University of Virginia, Charlottesville, VA, United States
| | - James Edwards
- School of Nursing, University of Virginia, Charlottesville, VA, United States
| | - Tabor Flickinger
- School of Medicine, University of Virginia, Charlottesville, VA, United States
| | - David Ling
- School of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Laura E Barnes
- School of Engineering & Applied Science, University of Virginia, Charlottesville, VA, United States
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Bloom JR, Marshall DC, Rodriguez-Russo C, Martin E, Jones JA, Dharmarajan KV. Prognostic disclosure in oncology - current communication models: a scoping review. BMJ Support Palliat Care 2022; 12:167-177. [PMID: 35144938 DOI: 10.1136/bmjspcare-2021-003313] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 01/08/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Prognostic disclosure is essential to informed decision making in oncology, yet many oncologists are unsure how to successfully facilitate this discussion. This scoping review determines what prognostic communication models exist, compares and contrasts these models, and explores the supporting evidence. METHOD A protocol was created for this study using the Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols extension for Scoping Reviews. Comprehensive literature searches of electronic databases MEDLINE, EMBASE, PsycINFO and Cochrane CENTRAL were executed to identify relevant publications between 1971 and 2020. RESULTS In total, 1532 articles were identified, of which 78 met inclusion criteria and contained 5 communication models. Three of these have been validated in randomised controlled trials (the Serious Illness Conversation Guide, the Four Habits Model and the ADAPT acronym) and have demonstrated improved objective communication measures and patient reported outcomes. All three models emphasise the importance of exploring patients' illness understanding and treatment preferences, communicating prognosis and responding to emotion. CONCLUSION Communicating prognostic estimates is a core competency skill in advanced cancer care. This scoping review highlights available communication models and identifies areas in need of further assessment. Such areas include how to maintain learnt communication skills for lifelong practice, how to assess patient and caregiver understanding during and after these conversations, and how to best scale these protocols at the institutional and national levels.
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Affiliation(s)
- Julie Rachel Bloom
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Carlos Rodriguez-Russo
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Emily Martin
- Palliative Care Program, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Joshua Adam Jones
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kavita Vyas Dharmarajan
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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15
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Westendorp J, Evers AWM, Stouthard JML, Budding J, van der Wall E, Plum NMF, Velting M, Francke AL, van Dulmen S, Olde Hartman TC, Van Vliet LM. Mind your words: Oncologists' communication that potentially harms patients with advanced cancer: A survey on patient perspectives. Cancer 2021; 128:1133-1140. [PMID: 34762305 PMCID: PMC9298810 DOI: 10.1002/cncr.34018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 09/20/2021] [Accepted: 09/27/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Many complaints in medicine and in advanced illnesses are about communication. Little is known about which specific communications harm. This study explored the perspectives of patients with advanced cancer about potentially harmful communication behaviors by oncologists and helpful alternatives. METHODS An online survey design was used that was based on literature scoping and patient/clinician/researcher input. Patients with advanced cancer (n = 74) reflected on the potential harmfulness of 19 communication situations. They were asked whether they perceived the situation as one in which communication could be harmful (yes/no). If they answered "yes," they were asked whether they perceived the examples as harmful (yes/no) or helpful (yes/no) and to provide open comments. Results were analyzed quantitatively and qualitatively (content analysis). RESULTS Communication regarding information provision, prognosis discussion, decision-making, and empathy could be unnecessarily potentially harmful, and this occurred in various ways, such as making vague promises instead of concrete ones (92%), being too directive in decision-making (qualitative), and not listening to the patient (88%). Not all patients considered other situations potentially harmful (eg, introducing the option of refraining from anticancer therapy [49%] and giving too much [prognostic] information [60%]). Exploring each individual patients' needs/preferences seemed to be a precondition for helpful communication. CONCLUSIONS This article provides patient perspectives on oncologists' unnecessarily potentially harmful communication behaviors and offers practical tools to improve communication in advanced cancer care. Both preventable pitfalls and delicate challenges requiring an individualized approach, where exploration might help, are described. Although providing difficult and unwelcome news is a core task for clinicians, this study might help them to do so while preventing potentially unnecessary harm.
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Affiliation(s)
- Janine Westendorp
- Health, Medical, and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands
| | - Andrea W M Evers
- Health, Medical, and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands
| | | | | | - Elsken van der Wall
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Nicole M F Plum
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Mirjam Velting
- Dutch Breast Cancer Association (BVN), Utrecht, the Netherlands
| | - Anneke L Francke
- Netherlands Institute for Health Services Research, Utrecht, the Netherlands.,Amsterdam Public Health Institute, Vrije Universiteit, Amsterdam, the Netherlands
| | - Sandra van Dulmen
- Netherlands Institute for Health Services Research, Utrecht, the Netherlands.,Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Tim C Olde Hartman
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Liesbeth M Van Vliet
- Health, Medical, and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands
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16
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Janett-Pellegri C, Eychmüller AS. 'I Don't Have a Crystal Ball' - Why Do Doctors Tend to Avoid Prognostication? PRAXIS 2021; 110:914-924. [PMID: 34814721 DOI: 10.1024/1661-8157/a003785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Uncertainty, fear to harm the patient, discomfort handling the discussion and lack of time are the most cited barriers to prognostic disclosure. Physicians can be reassured that patients desire the truth about prognosis and can manage the discussion without harm, including the uncertainty of the information, if approached in a sensitive manner. Conversational guides could provide support in preparing such difficult conversations. Communicating 'with realism and hope' is possible, and anxiety is normal for both patients and clinicians during prognostic disclosure. As a clinician pointed out: 'I had asked a mentor once if it ever got easier. - No. But you get better at it.'
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Affiliation(s)
- Camilla Janett-Pellegri
- Service de Médicine Interne, Hôpital Cantonal Fribourg, Fribourg
- Universitäres Zentrum für Palliative Care, Inselspital, Universitätsspital Bern, Bern
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17
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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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18
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Anderson RJ, Stone PC, Low JTS, Bloch S. Transitioning out of prognostic talk in discussions with families of hospice patients at the end of life: A conversation analytic study. PATIENT EDUCATION AND COUNSELING 2021; 104:1075-1085. [PMID: 33199091 DOI: 10.1016/j.pec.2020.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To examine transitions out of prognostic talk in interactions between clinicians and the relatives and friends of imminently dying hospice patients. METHODS Conversation analysis of 20 conversations between specialist palliative care clinicians and the families of imminently dying patients in a hospice. RESULTS Following the provision and acknowledgement of a prognostic estimate, clinicians were able to transition gradually towards making assurances about actions that could be taken to ensure patient comfort. When families raised concerns or questions, this transition sequence was extended. Clinicians addressed these questions or concerns and then pivoted to action-oriented talk, most often relating to patient comfort. CONCLUSION In conversations at the end of life, families and clinicians used practices to transition from the uncertainty of prognosis to more certain, controllable topics including comfort care. PRACTICE IMPLICATIONS In a context in which there is a great deal of uncertainty, transitioning towards talk on comfort care can emphasise action and the continued care of the patient and their family.
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Affiliation(s)
- Rebecca J Anderson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK.
| | - Patrick C Stone
- Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK
| | - Joseph T S Low
- Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK
| | - Steven Bloch
- Department of Language and Cognition, Division of Psychology and Language Sciences, UCL, London, UK
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19
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Abstract
PURPOSE OF REVIEW Our goal was to provide healthcare professionals (HCPs) with evidence-based data about what can be done to handle prognostic discussions with empathy. RECENT FINDINGS First, disclosing prognosis involves a good reason to do so and making sure that the patient will be able to process the discussion. Second, communication tips are given for the three dimensions of empathy: "establishing rapport with the patient," which should not be overlooked; the emotional dimension, which involves an accurate understanding of the patient and communication skills; and the "active/positive" dimension which is about giving hope, explaining things clearly and helping patients take control with shared decision-making and a planned future. Although communication tips are helpful, empathy training should be based more on the development of HCPs' emotional skills, in order to help them regulate their emotions and thus be more comfortable with those of patients and families. Furthermore, research into empathy toward minorities and relatives is needed.
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Affiliation(s)
- Sophie Lelorain
- Univ. Lille, CNRS, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, F-59000, Lille, France.
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20
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Abstract
This study focuses on oncology interviews with returning patients who have been diagnosed with cancer, are undergoing various treatment regimens, and have been informed by doctors of their current “stable” medical condition. Conversation analysis was conducted on 112 video recorded and transcribed oncology interviews involving 30 doctors. In 44 of 112 (39 percent) interviews, doctors announced stable as good cancer news. In response, patients rarely affirm stable as good news for them. Nonreponses and minimal responses lacking enthusiasm occurred in one third of instances, and in the majority of interactions, patients resisted and questioned impacts of the need to endure ongoing treatments yet reduced possibilities for cancer shrinkage or remission. These interactional disjunctures reflect epistemic dilemmas for doctors seeking to provide quality care and especially for patients who must simultaneously manage good and bad news. Findings extend ongoing research and theoretical development that address the social psychological burdens inherent in disappointment, medical diagnosis, and prognosis. A focus on how patients and doctors manage stable cancer reveals recurring tensions between patients’ lay experiences with illness and how doctors give biomedical priority to controlling cancer.
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Affiliation(s)
- Wayne A. Beach
- San Diego State University, San Diego, CA, USA
- University of California, San Diego
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21
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Riaz F, Gan G, Li F, Davidoff AJ, Adelson KB, Presley CJ, Adamson BJ, Shaw P, Parikh RB, Mamtani R, Gross CP. Adoption of Immune Checkpoint Inhibitors and Patterns of Care at the End of Life. JCO Oncol Pract 2020; 16:e1355-e1370. [PMID: 32678688 PMCID: PMC8189605 DOI: 10.1200/op.20.00010] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2020] [Indexed: 01/12/2023] Open
Abstract
PURPOSE As immune checkpoint inhibitors (ICIs) have transformed the care of patients with cancer, it is unclear whether treatment at the end of life (EOL) has changed. Because aggressive therapy at the EOL is associated with increased costs and patient distress, we explored the association between the Food and Drug Administration (FDA) approvals of ICIs and treatment patterns at the EOL. METHODS We conducted a retrospective, observational study using patient-level data from a nationwide electronic health record-derived database. Patients had advanced melanoma, non-small-cell lung cancer (NSCLC; cancer types with an ICI indication), or microsatellite stable (MSS) colon cancer (a cancer type without an ICI indication) and died between 2013 and 2017. We calculated annual proportions of decedents who received systemic cancer therapy in the final 30 days of life, using logistic regression to model the association between the post-ICI FDA approval time and use of systemic therapy at the EOL, adjusting for patient characteristics. We assessed the use of chemotherapy or targeted/biologic therapies at the EOL, before and after FDA approval of ICIs using Pearson chi-square test. RESULTS There was an increase in use of EOL systemic cancer therapy in the post-ICI approval period for both melanoma (33.9% to 43.2%; P < .001) and NSCLC (37.4% to 40.3%; P < .001), with no significant change in use of systemic therapy in MSS colon cancer. After FDA approval of ICIs, patients with NSCLC and melanoma had a decrease in the use of chemotherapy, with a concomitant increase in use of ICIs at the EOL. CONCLUSION The adoption of ICIs was associated with a substantive increase in the use of systemic therapy at the EOL in melanoma and a smaller yet significant increase in NSCLC.
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Affiliation(s)
- Fauzia Riaz
- Cancer Outcomes Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, CT
- Stanford University School of Medicine, Stanford, CA
| | - Geliang Gan
- Yale Cancer Center, New Haven, CT
- Yale Center for Analytical Sciences, New Haven, CT
| | - Fangyong Li
- Yale Cancer Center, New Haven, CT
- Yale Center for Analytical Sciences, New Haven, CT
| | - Amy J. Davidoff
- Cancer Outcomes Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, CT
- Yale Cancer Center, New Haven, CT
| | - Kerin B. Adelson
- Cancer Outcomes Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, CT
- Yale Cancer Center, New Haven, CT
| | - Carolyn J. Presley
- Cancer Outcomes Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, CT
- The Ohio State University Comprehensive Cancer Center and The James Cancer Hospital/Solove Research Institute, Columbus, OH
| | | | | | - Ravi B. Parikh
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Ronac Mamtani
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Cary P. Gross
- Cancer Outcomes Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, CT
- Yale Cancer Center, New Haven, CT
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22
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Pini S, Hackett J, Taylor S, Bekker HL, Kite S, Bennett MI, Ziegler L. Patient and professional experiences of palliative care referral discussions from cancer services: A qualitative interview study. Eur J Cancer Care (Engl) 2020; 30:e13340. [PMID: 33051957 DOI: 10.1111/ecc.13340] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 05/20/2020] [Accepted: 08/07/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this paper was to identify current barriers, facilitators and experiences of raising and discussing palliative care with people with advanced cancer. METHODS Semi-structured interviews were conducted with patients with advanced cancer and healthcare professionals (HCPs). Patients were included who had and had not been referred to palliative care. Transcripts were analysed using framework analysis. RESULTS Twenty-four patients and eight HCPs participated. Two overarching themes and five sub-themes emerged: Theme one-referral process: timing and triggers, responsibility. Theme two-engagement: perception of treatment, prognosis and palliative care, psychological and emotional preparedness for discussion, and understanding how palliative care could benefit present and future care. CONCLUSION There is a need to identify suitable patients earlier in their cancer trajectory, address misconceptions about palliative care, treatment and prognosis, and better prepare patients and HCPs to have meaningful conversations about palliative care. Patients and HCPs need to establish and communicate the relevance of palliative care to the patient's current and future care, and be clear about the referral process.
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Affiliation(s)
- Simon Pini
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Julia Hackett
- Martin House Research Centre, Social Policy Research Unit, University of York, York, UK
| | - Sally Taylor
- The Christie NHS Foundation Trust, Manchester, UK
| | - Hilary L Bekker
- Leeds Unit for Complex Intervention Development (LUCID), Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Lucy Ziegler
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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23
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Singh S, Eguchi M, Min SJ, Fischer S. Outcomes of Patients With Cancer Discharged to a Skilled Nursing Facility After Acute Care Hospitalization. J Natl Compr Canc Netw 2020; 18:856-865. [PMID: 32634778 PMCID: PMC8370039 DOI: 10.6004/jnccn.2020.7534] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 01/10/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND After discharge from an acute care hospitalization, patients with cancer may choose to pursue rehabilitative care in a skilled nursing facility (SNF). The objective of this study was to examine receipt of anticancer therapy, death, readmission, and hospice use among patients with cancer who discharge to an SNF compared with those who are functionally able to discharge to home or home with home healthcare in the 6 months after an acute care hospitalization. METHODS A population-based cohort study was conducted using the SEER-Medicare database of patients with stage II-IV colorectal, pancreatic, bladder, or lung cancer who had an acute care hospitalization between 2010 and 2013. A total of 58,770 cases were identified and patient groups of interest were compared descriptively using means and standard deviations for continuous variables and frequencies and percentages for categorical variables. Logistic regression was used to compare patient groups, adjusting for covariates. RESULTS Of patients discharged to an SNF, 21%, 17%, and 2% went on to receive chemotherapy, radiotherapy, and targeted chemotherapy, respectively, compared with 54%, 28%, and 6%, respectively, among patients discharged home. Fifty-six percent of patients discharged to an SNF died within 6 months of their hospitalization compared with 36% discharged home. Thirty-day readmission rates were 29% and 28% for patients discharged to an SNF and home, respectively, and 12% of patients in hospice received <3 days of hospice care before death regardless of their discharge location. CONCLUSIONS Patients with cancer who discharge to an SNF are significantly less likely to receive subsequent oncologic treatment of any kind and have higher mortality compared with patients who discharge to home after an acute care hospitalization. Further research is needed to understand and address patient goals of care before discharge to an SNF.
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Affiliation(s)
- Sarguni Singh
- 1Division of Hospital Medicine, University of Colorado Denver
| | | | | | - Stacy Fischer
- 4Division of General Internal Medicine, University of Colorado Denver, Aurora, Colorado
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24
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Sedhom R, Gupta A, Von Roenn J, Smith TJ. The Case for Focused Palliative Care Education in Oncology Training. J Clin Oncol 2020; 38:2366-2368. [PMID: 32271674 DOI: 10.1200/jco.20.00236] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ramy Sedhom
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Arjun Gupta
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | | | - Thomas J Smith
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
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25
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Back AL. Patient-Clinician Communication Issues in Palliative Care for Patients With Advanced Cancer. J Clin Oncol 2020; 38:866-876. [PMID: 32023153 DOI: 10.1200/jco.19.00128] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The delivery of palliative care to patients with advanced cancer and their families, whether done by oncology clinicians or palliative care clinicians, requires patient-centered communication. Excellent communication can introduce patients and families to palliative care in a nonthreatening way, build patient trust, enable symptom control, strengthen coping, and guide decision making. This review covers deficiencies in the current state of communication, patient preferences for communication about palliative care topics, best practices for communication, and the roles of education and system intervention. Communication is a two-way, relational process that is influenced by context, culture, words, and gestures, and it is one of the most important ways that clinicians influence the quality of medical care that patients and their families receive.
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Chu C, Anderson R, White N, Stone P. Prognosticating for Adult Patients With Advanced Incurable Cancer: a Needed Oncologist Skill. Curr Treat Options Oncol 2020; 21:5. [PMID: 31950387 PMCID: PMC6965075 DOI: 10.1007/s11864-019-0698-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Patients with advanced cancer and their families commonly seek information about prognosis to aid decision-making in medical (e.g. surrounding treatment), psychological (e.g. saying goodbye), and social (e.g. getting affairs in order) domains. Oncologists therefore have a responsibility to identify and address these requests by formulating and sensitively communicating information about prognosis. Current evidence suggests that clinician predictions are correlated with actual survival but tend to be overestimations. In an attempt to cultivate prognostic skills, it is recommended that clinicians practice formulating and recording subjective estimates of prognosis in advanced cancer patient’s medical notes. When possible, a multi-professional prognostic estimate should be sought as these may be more accurate than individual predictions alone. Clinicians may consider auditing the accuracy of their predictions periodically and using feedback from this process to improve their prognostic skills. Clinicians may also consider using validated prognostic tools to complement their clinical judgements. However, there is currently only limited evidence about the comparative accuracy of different prognostic tools or the extent to which these measures are superior to clinical judgement. Oncologists and palliative care physicians should ensure that they receive adequate training in advanced communication skills, which builds upon their pre-existing skills, to sensitively deliver information on prognosis. In particular, clinicians should acknowledge their own prognostic uncertainty and should emphasise the supportive care that can continue to be provided after stopping cancer-directed therapies.
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Affiliation(s)
- Christina Chu
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London (UCL), 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Rebecca Anderson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London (UCL), 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Nicola White
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London (UCL), 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Patrick Stone
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London (UCL), 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
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27
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Tate A. Invoking death: How oncologists discuss a deadly outcome. Soc Sci Med 2019; 246:112672. [PMID: 31954997 DOI: 10.1016/j.socscimed.2019.112672] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 10/30/2019] [Accepted: 11/07/2019] [Indexed: 11/19/2022]
Abstract
Existing sociological research documents patient and physician reticence to discuss death in the context of a patient's end of life. This study offers a new approach to analyzing how death gets discussed in medical interaction. Using a corpus of 90 video-recorded oncology visits and conversation analytic (CA) methods, this analysis reveals that when existing parameters are expanded to look at mentions of death outside of the end-of-life context, physicians do discuss death with their patients. Specifically, the most frequent way physicians invoke death is in a persuasive context during treatment recommendation discussions. When patients demonstrate active or passive resistance to a recommendation, physicians invoke the possibility of the patient's death to push back against this resistance and lobby for treatment. Occasionally, physicians invoke death in instances where resistance is anticipated but never actualized. Similarly, death invocations function for treatment advocacy. Ultimately, this study concludes that physicians in these data invoke death to leverage their professional authority for particular treatment outcomes.
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Affiliation(s)
- Alexandra Tate
- Department of Medicine, The University of Chicago, 5841 S. Maryland Ave, MC1005, M200, Chicago, IL 60637, United States.
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28
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Derry HM, Epstein AS, Lichtenthal WG, Prigerson HG. Emotions in the room: common emotional reactions to discussions of poor prognosis and tools to address them. Expert Rev Anticancer Ther 2019; 19:689-696. [PMID: 31382794 DOI: 10.1080/14737140.2019.1651648] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction: Advanced cancer patients often want prognostic information, and discussions of prognosis have been shown to enhance patient understanding of their illness. Such discussions can lead to high-quality, value-consistent care at the end of life, yet they are also often emotionally challenging. Despite how common and normal it is for patients to experience transient emotional distress when receiving 'bad news' about prognosis, emotional responses have been under-addressed in existing literature on prognostic discussions. Areas covered: Drawing upon psychology research, principles of skilled clinical communication, and published approaches to discussions of serious illness, we summarize patients' common emotional reactions and coping strategies. We then provide suggestions for how to respond to them in clinic. Expert opinion: Ultimately, effective management of emotional reactions to bad news may lead to earlier, more frequent, and more transparent discussions of prognosis, thus promoting cancer patients' understanding of, and adjustment to, their illness and improving the quality of their end-of-life care.
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Affiliation(s)
| | - Andrew S Epstein
- Weill Cornell Medicine , New York , NY , USA.,Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Wendy G Lichtenthal
- Weill Cornell Medicine , New York , NY , USA.,Memorial Sloan Kettering Cancer Center , New York , NY , USA
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29
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LeBlanc TW, Marron JM, Ganai S, McGinnis MM, Spence RA, Tenner L, Tap WD, Hlubocky FJ. Prognostication and Communication in Oncology. J Oncol Pract 2019; 15:208-215. [DOI: 10.1200/jop.18.00647] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Sabha Ganai
- Southern Illinois University School of Medicine, Springfield, IL
| | | | | | - Laura Tenner
- University of Texas Health Cancer Center at San Antonio, San Antonio, TX
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Pino M, Parry R. Talking about death and dying: Findings and insights from five conversation analytic studies. PATIENT EDUCATION AND COUNSELING 2019; 102:185-187. [PMID: 30765048 DOI: 10.1016/j.pec.2019.01.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Marco Pino
- School of Social Sciences, Loughborough University, Margaret Keay Rd, LE11 3TU, UK.
| | - Ruth Parry
- School of Social Sciences, Loughborough University, Margaret Keay Rd, LE11 3TU, UK
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Cortez D, Maynard DW, Campbell TC. Creating space to discuss end-of-life issues in cancer care. PATIENT EDUCATION AND COUNSELING 2019; 102:216-222. [PMID: 30007763 PMCID: PMC6571206 DOI: 10.1016/j.pec.2018.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 06/26/2018] [Accepted: 07/02/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Analyze entire oncology clinical visits and examine instances in which oncologists have to break the bad news that patients' treatments are no longer effective. METHODS Using conversation analysis we examine 128 audio recorded conversations between terminal cancer patients, their caregivers, and oncologists. RESULTS When oncologists break the bad news that a patient's treatment is no longer effective, they often use a conversational device we call an "exhausted current treatment" (ECT) statement, which avoids discussing prognosis in favor of further discussing treatment options. Analysis suggests that improving and prioritizing patient-centered care and shared decision making is possible if we first understand the social organization of clinical visits. CONCLUSIONS ECT statements and their movement towards discussing treatment options means that opportunities are bypassed for patients and caregivers to process or discuss scan results, and their prognostic implications. PRACTICE IMPLICATIONS When oncologists and patients, by fixating on treatment options, bypass opportunities to discuss the meaning of scan results, they fail to realize other goals associated with prognostic awareness. Talking about what scans mean may add minutes to that part of the clinic visit, but can create efficiencies that conserve overall time. We recommend that oncologists, after delivering scan news, ask, "Would you like discuss what this means?".
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Affiliation(s)
- Dagoberto Cortez
- Department of Sociology, University of Wisconsin-Madison, Madison, United States.
| | - Douglas W Maynard
- Department of Sociology, University of Wisconsin-Madison, Madison, United States
| | - Toby C Campbell
- Department of Internal Medicine, Division on Hematology-Oncology, University of Wisconsin-Madison, Madison, United States; School of Nursing, University of Wisconsin-Madison, Madison, United States
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Pino M, Parry R. How and when do patients request life-expectancy estimates? Evidence from hospice medical consultations and insights for practice. PATIENT EDUCATION AND COUNSELING 2019; 102:223-237. [PMID: 29685640 DOI: 10.1016/j.pec.2018.03.026] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 03/02/2018] [Accepted: 03/28/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To break new ground by directly examining how patients seek life-expectancy estimates, and how doctors support them in doing so. METHODS Conversation analytic examination of 10 recorded UK hospice consultations involving 3 palliative specialists. RESULTS Life-expectancy estimate episodes frequently begin after a doctor has given a patient an opportunity to shape the consultation agenda. Rather than posing direct questions, patients cautiously display their interest in receiving an estimate using statements. These often contain preparatory information about: what they already know about their prognosis, their perspective on it, and readiness to hear more. When patients do not provide this information, doctors invite it before giving an estimate. Patients' companions also contribute to this preparatory work. CONCLUSION Doctors, patients, and companions collaboratively work to prepare a conversational environment wherein emotional states and uncertainties have been addressed prior to delivery of the actual estimate. This helps manage both possible emotional distress, and prognostic uncertainty entailed in seeking and delivering estimates. PRACTICE IMPLICATIONS Clinicians should be mindful that rather than overtly requesting estimates, patients may seek them more cautiously. Before delivering estimates, doctors can support patients to articulate their existing understanding and perspective regarding prognosis, and their readiness to hear more.
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Affiliation(s)
- Marco Pino
- Department of Social Sciences, Loughborough University, Brockington Building, Margaret Keay Rd, Loughborough, Leicestershire, LE11 3TU, UK.
| | - Ruth Parry
- Department of Social Sciences, Loughborough University, Brockington Building, Margaret Keay Rd, Loughborough, Leicestershire, LE11 3TU, UK.
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Step MM, Ferber GA, Downs-Holmes C, Silverman P. Feasibility of a team based prognosis and treatment goal discussion (T-PAT) with women diagnosed with advanced breast cancer. PATIENT EDUCATION AND COUNSELING 2019; 102:77-84. [PMID: 30150125 DOI: 10.1016/j.pec.2018.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 08/06/2018] [Accepted: 08/10/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To assess the feasibility of a team-based prognosis and treatment goal discussion for women living with advanced breast cancer. METHODS Female patients diagnosed with advanced breast cancer (n = 25) participated in a mixed methods study that evaluated the feasibility and effects of a planned and structured prognosis discussion. Audio analysis of the intervention appointments was conducted to assess intervention feasibility. Patient self-reports of prognosis related beliefs and treatment preferences were compared across intervention and usual care groups. RESULTS Most patients found the T-PAT appointment challenging but worthwhile. Intervention uptake by clinicians was good, but some fidelity disruptions were noted. T-PAT participants were more likely to hold realistic beliefs about disease curability after the appointment. CONCLUSION Productive prognosis discussions can be delivered effectively by a practice-based clinical team within a semi-structured patient education appointment. It was perceived by patients with advanced breast cancer as both valuable and acceptable. T-PAT clinicians found the intervention easy to deliver. PRACTICE IMPLICATIONS Regular implementation of T-PAT may help clinicians' build prognosis discussion communication skills. T-PAT documentation provides valuable information that can be used to tailor ongoing care.
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Affiliation(s)
- Mary M Step
- College of Public Health at Kent State University, Lowry Hall, 750 Hilltop Dr., Kent, OH, 44242, USA.
| | - Gretchen A Ferber
- Northeast Ohio Medical University, 4209 OH-44, Rootstown, OH, 44272, USA
| | - Catherine Downs-Holmes
- University Hospitals Seidman Cancer Center, 11100 Euclid Ave., Cleveland, OH, 44106, USA
| | - Paula Silverman
- School of Medicine at Case Western Reserve University, 11000 Cedar Ave, Cleveland, OH, USA
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Singh S, Rodriguez A, Lee D, Min SJ, Fischer S. Usefulness of the Surprise Question on an Inpatient Oncology Service. Am J Hosp Palliat Care 2018; 35:1421-1425. [PMID: 29783852 DOI: 10.1177/1049909118777990] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Prognostication of survival in patients with advanced cancer has been challenging and contributes to poor illness understanding. Prognostic disagreement occurs even among providers and is a less studied phenomenon. OBJECTIVE We introduced the surprise question (SQ), "Would I be surprised if this patient died in the next 1 year, 6 months, and 1 month?," at multidisciplinary rounds to increase palliative care referrals through the introduction of this prognostic prompt. DESIGN, SETTING, PATIENTS This quality improvement project took place from March 2016 to May 2016 on the medical oncology service at a tertiary academic medical center. The question was asked 3 times a week at multidisciplinary rounds which are attended by the hospital medicine provider, palliative care provider, and consulting oncologist. Primary oncologists and bedside nurses were also asked the SQ. MEASUREMENTS Referral rates to outpatient palliative care clinic, community-based palliative care clinic, inpatient palliative care consults, and hospice 3 months prior to, during, and 5 months postintervention. RESULTS Regular discussion of prognosis of patients with cancer in an inpatient medical setting did not increase referrals to inpatient or outpatient palliative care or hospice. Increased clinical experience impacted hospital medicine providers and bedside nurses' estimation of prognosis differently than oncology providers. Medical oncologists were significantly more optimistic than hospital medicine providers.
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Affiliation(s)
- Sarguni Singh
- 1 Division of Hospital Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Adrian Rodriguez
- 2 College of Nursing, University of Colorado Denver, Aurora, CO, USA
| | - Darrell Lee
- 2 College of Nursing, University of Colorado Denver, Aurora, CO, USA
| | - Sung-Joon Min
- 3 Division of Health Care Policy and Research, University of Colorado Denver, Aurora, CO, USA
| | - Stacy Fischer
- 4 Division of General Internal Medicine, University of Colorado Denver, Aurora, CO, USA
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Sisk BA, Kang TI, Mack JW. How Parents of Children With Cancer Learn About Their Children's Prognosis. Pediatrics 2018; 141:peds.2017-2241. [PMID: 29208726 DOI: 10.1542/peds.2017-2241] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine which prognostic information sources parents find informative and which are associated with better parental understanding of prognosis. METHODS Prospective, questionnaire-based cohort study of parents and physicians of children with cancer at 2 academic pediatric hospitals. We asked parents how they learned about prognoses and evaluated relationships between information sources and prognostic understanding, defined as accuracy versus optimism. We excluded parents with pessimistic estimates and whose children had such good prognoses that optimism relative to the physician was impossible. Analytic cohort of 256 parent-physician pairs. RESULTS Most parents considered explicit sources (conversations with oncologists at diagnosis, day-to-day conversations with oncologists, and conversations with nurses) "very" or "extremely" informative (73%-85%). Implicit sources (parent's sense of how child was doing or how oncologist seemed to feel child was doing) were similarly informative (84%-87%). Twenty-seven percent (70/253) of parents reported prognostic estimates matching physicians' estimates. Parents who valued implicit information had lower prognostic accuracy (odds ratio [OR] 0.50; 95% confidence interval 0.29-0.88), especially those who relied on a "general sense of how my child's oncologist seems to feel my child is doing" (OR 0.47; 0.22-0.99). Parents were more likely to use implicit sources if they reported receiving high-quality prognostic information (OR 3.02; 1.41-6.43), trusted the physician (OR 2.01; 1.01-3.98), and reported high-quality physician communication (OR 1.81; 1.00-3.27). CONCLUSIONS Reliance on implicit sources was associated with overly-optimistic prognostic estimates. Parents who endorsed strong, trusting relationships with physicians were not protected against misinformation.
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Affiliation(s)
- Bryan A Sisk
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri;
| | - Tammy I Kang
- Section of Pediatric Palliative Care, Texas Children's Hospital, Houston, Texas.,Department of Pediatrics, College of Medicine, Baylor University, Houston, Texas
| | - Jennifer W Mack
- Division of Population Sciences, Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; and.,Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts
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Smith CB, Phillips T, Smith TJ. Using the New ASCO Clinical Practice Guideline for Palliative Care Concurrent With Oncology Care Using the TEAM Approach. Am Soc Clin Oncol Educ Book 2017; 37:714-723. [PMID: 28561696 DOI: 10.1200/edbk_175474] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Palliative care alongside usual oncology care is now recommended by ASCO as the standard of care for any patient with advanced cancer on the basis of multiple randomized trials that show better results with concurrent care than with usual oncology care. Some benefits include better quality of life, better symptom management, reduced anxiety and depression, less caregiver distress, more accordance of care with the wishes of the patient, and less aggressive end-of-life care. Several studies show a survival advantage of several months, and many show considerable cost savings: better care at an affordable cost. However, there are not enough palliative care specialists available, so oncologists must practice exemplary primary palliative care. Protocols used in the clinical trials, similar to those designed for new chemotherapy agents, help oncologists use the TEAM approach of extra time, typically an hour a month spent with the palliative care team; education, especially about prognostic awareness and realistic options, which include formal setting of goals of care and discussion of advance directives; formal assessments for symptoms and for spiritual and psychosocial health; and management by an interdisciplinary team. These are all potentially accomplished by an oncology practice to replicate the services provided by concurrent palliative care.
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Affiliation(s)
- Cardinale B Smith
- From the Tisch Cancer Institute, Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; CHRISTUS St. Frances Cabrini Hospital, Alexandria, LA; Harry J. Duffey Family Patient and Family Services Program, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Tanyanika Phillips
- From the Tisch Cancer Institute, Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; CHRISTUS St. Frances Cabrini Hospital, Alexandria, LA; Harry J. Duffey Family Patient and Family Services Program, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Thomas J Smith
- From the Tisch Cancer Institute, Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; CHRISTUS St. Frances Cabrini Hospital, Alexandria, LA; Harry J. Duffey Family Patient and Family Services Program, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutions, Baltimore, MD
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Smith TJ, Hanna N, Johnson D, Baker S, Biermann WA, Brahmer J, Ellis PM, Giaccone G, Hesketh PJ, Jaiyesimi I, Leighl NB, Riely GJ, Schiller JH, Schneider BJ, Tashbar J, Temin S, Masters G. Case for Stopping Targeted Therapy When Lung Cancer Progresses on Treatment in Hospice-Eligible Patients. J Oncol Pract 2017; 13:780-783. [PMID: 28981389 DOI: 10.1200/jop.2017.027367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Thomas J Smith
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Nasser Hanna
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - David Johnson
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Sherman Baker
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - William A Biermann
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Julie Brahmer
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Peter M Ellis
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Giuseppe Giaccone
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Paul J Hesketh
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Ishmael Jaiyesimi
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Natasha B Leighl
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Gregory J Riely
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Joan H Schiller
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Bryan J Schneider
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Joan Tashbar
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Sarah Temin
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Gregory Masters
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
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Henselmans I, Smets EMA, Han PKJ, de Haes HCJC, Laarhoven HWMV. How long do I have? Observational study on communication about life expectancy with advanced cancer patients. PATIENT EDUCATION AND COUNSELING 2017; 100:1820-1827. [PMID: 28511804 DOI: 10.1016/j.pec.2017.05.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 05/01/2017] [Accepted: 05/05/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To examine how communication about life expectancy is initiated in consultations about palliative chemotherapy, and what prognostic information is presented. METHODS Patients with advanced cancer (n=41) with a median life expectancy <1year and oncologists (n=6) and oncologists-in-training (n=7) meeting with them in consultations (n=62) to discuss palliative chemotherapy were included. Verbatim transcripts of audio-recorded consultations were analyzed using MAXqda10. RESULTS Life expectancy was addressed in 19 of 62 of the consultations. In all cases, patients took the initiative, most often through direct questions. Estimates were provided in 12 consultations in various formats: the likelihood of experiencing a significant event, point estimates or general time scales of "months to years", often with an emphasis on the "years". The indeterminacy of estimates was consistently stressed. Also their potential inadequacy was regularly addressed, often by describing beneficial prognostic predictors for the specific patient. Oncologists did not address the reliability or precision of estimates. CONCLUSION Oncologists did not initiate talk about life expectancy, they used different formats, emphasized the positive and stressed unpredictability, yet not ambiguity of estimates. PRACTICE IMPLICATIONS Prognostic communication should be part of the medical curriculum. Further research should address the effect of different formats of information provision.
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Affiliation(s)
- I Henselmans
- Academic Medical Center, Department of Medical Psychology, Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam, The Netherlands; Amsterdam Public Health research institute, Amsterdam, The Netherlands.
| | - E M A Smets
- Academic Medical Center, Department of Medical Psychology, Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam, The Netherlands; Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - P K J Han
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME, USA; Tufts University Clinical and Translational Sciences Institute, Boston, MA, USA
| | - H C J C de Haes
- Academic Medical Center, Department of Medical Psychology, Amsterdam, The Netherlands
| | - H W M van Laarhoven
- Cancer Center Amsterdam, Amsterdam, The Netherlands; Academic Medical Center, Department of Medical Oncology, Amsterdam, The Netherlands
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Gilligan T, Coyle N, Frankel RM, Berry DL, Bohlke K, Epstein RM, Finlay E, Jackson VA, Lathan CS, Loprinzi CL, Nguyen LH, Seigel C, Baile WF. Patient-Clinician Communication: American Society of Clinical Oncology Consensus Guideline. J Clin Oncol 2017; 35:3618-3632. [PMID: 28892432 DOI: 10.1200/jco.2017.75.2311] [Citation(s) in RCA: 304] [Impact Index Per Article: 43.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose To provide guidance to oncology clinicians on how to use effective communication to optimize the patient-clinician relationship, patient and clinician well-being, and family well-being. Methods ASCO convened a multidisciplinary panel of medical oncology, psychiatry, nursing, hospice and palliative medicine, communication skills, health disparities, and advocacy experts to produce recommendations. Guideline development involved a systematic review of the literature and a formal consensus process. The systematic review focused on guidelines, systematic reviews and meta-analyses, and randomized controlled trials published from 2006 through October 1, 2016. Results The systematic review included 47 publications. With the exception of clinician training in communication skills, evidence for many of the clinical questions was limited. Draft recommendations underwent two rounds of consensus voting before being finalized. Recommendations In addition to providing guidance regarding core communication skills and tasks that apply across the continuum of cancer care, recommendations address specific topics, such as discussion of goals of care and prognosis, treatment selection, end-of-life care, facilitating family involvement in care, and clinician training in communication skills. Recommendations are accompanied by suggested strategies for implementation. Additional information is available at www.asco.org/supportive-care-guidelines and www.asco.org/guidelineswiki .
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Affiliation(s)
- Timothy Gilligan
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nessa Coyle
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Richard M Frankel
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Donna L Berry
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kari Bohlke
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ronald M Epstein
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Esme Finlay
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Vicki A Jackson
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Christopher S Lathan
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Charles L Loprinzi
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lynne H Nguyen
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Carole Seigel
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Walter F Baile
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
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Bakitas MA, El-Jawahri A, Farquhar M, Ferrell B, Grudzen C, Higginson I, Temel JS, Zimmermann C, Smith TJ. The TEAM Approach to Improving Oncology Outcomes by Incorporating Palliative Care in Practice. J Oncol Pract 2017; 13:557-566. [DOI: 10.1200/jop.2017.022939] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Palliative care (PC) concurrent with usual oncology care is now the standard of care that is recommended for any patient with advanced cancer to begin within 8 weeks of diagnosis on the basis of evidence-driven national clinical practice guidelines; however, there are not enough interdisciplinary palliative care teams to provide such care. How and what can an oncology office incorporate into usual care, borrowing the tools used in PC randomized clinical trials (RCTs), to improve care for patients and their caregivers? We reviewed the multiple RCTs for common practical elements and identified methods and techniques that oncologists can use to deliver some parts of concurrent interdisciplinary PC. We recommend the standardized assessment of patient-reported outcomes, including the evaluation of symptoms with such tools as the Edmonton or Memorial Symptom Assessment Scales, spirituality with the FICA Spiritual History Tool or similar questions, and psychosocial distress with the Distress Thermometer. All patients should be assessed for how they prefer to receive information, their current understanding of their situation, and if they have considered some advance care planning. Approximately 1 hour of additional time with the patient is required each month. If the oncologist does not have established ties with spiritual care and social work, he or she should establish these relationships for counseling as required. Caregivers should be asked about coping and support needs. Oncologists can adapt PC techniques to achieve results that are similar to those in the RCTs of PC plus usual care compared with usual care alone. This is comparable to using data from RCTs of trastuzamab or placebo, adopting what was used in the RCTs without modification or dilution.
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Affiliation(s)
- Marie A. Bakitas
- University of Alabama at Birmingham, AL; Partners–Massachusetts General Hospital, Boston, MA; City of Hope Medical Center, Duarte, CA; New York University School of Medicine, New York, NY; University of East Anglia, Norwich; Kings College London, London, United Kingdom; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; and Johns Hopkins University, Baltimore, MD
| | - Areej El-Jawahri
- University of Alabama at Birmingham, AL; Partners–Massachusetts General Hospital, Boston, MA; City of Hope Medical Center, Duarte, CA; New York University School of Medicine, New York, NY; University of East Anglia, Norwich; Kings College London, London, United Kingdom; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; and Johns Hopkins University, Baltimore, MD
| | - Morag Farquhar
- University of Alabama at Birmingham, AL; Partners–Massachusetts General Hospital, Boston, MA; City of Hope Medical Center, Duarte, CA; New York University School of Medicine, New York, NY; University of East Anglia, Norwich; Kings College London, London, United Kingdom; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; and Johns Hopkins University, Baltimore, MD
| | - Betty Ferrell
- University of Alabama at Birmingham, AL; Partners–Massachusetts General Hospital, Boston, MA; City of Hope Medical Center, Duarte, CA; New York University School of Medicine, New York, NY; University of East Anglia, Norwich; Kings College London, London, United Kingdom; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; and Johns Hopkins University, Baltimore, MD
| | - Corita Grudzen
- University of Alabama at Birmingham, AL; Partners–Massachusetts General Hospital, Boston, MA; City of Hope Medical Center, Duarte, CA; New York University School of Medicine, New York, NY; University of East Anglia, Norwich; Kings College London, London, United Kingdom; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; and Johns Hopkins University, Baltimore, MD
| | - Irene Higginson
- University of Alabama at Birmingham, AL; Partners–Massachusetts General Hospital, Boston, MA; City of Hope Medical Center, Duarte, CA; New York University School of Medicine, New York, NY; University of East Anglia, Norwich; Kings College London, London, United Kingdom; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; and Johns Hopkins University, Baltimore, MD
| | - Jennifer S. Temel
- University of Alabama at Birmingham, AL; Partners–Massachusetts General Hospital, Boston, MA; City of Hope Medical Center, Duarte, CA; New York University School of Medicine, New York, NY; University of East Anglia, Norwich; Kings College London, London, United Kingdom; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; and Johns Hopkins University, Baltimore, MD
| | - Camilla Zimmermann
- University of Alabama at Birmingham, AL; Partners–Massachusetts General Hospital, Boston, MA; City of Hope Medical Center, Duarte, CA; New York University School of Medicine, New York, NY; University of East Anglia, Norwich; Kings College London, London, United Kingdom; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; and Johns Hopkins University, Baltimore, MD
| | - Thomas J. Smith
- University of Alabama at Birmingham, AL; Partners–Massachusetts General Hospital, Boston, MA; City of Hope Medical Center, Duarte, CA; New York University School of Medicine, New York, NY; University of East Anglia, Norwich; Kings College London, London, United Kingdom; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; and Johns Hopkins University, Baltimore, MD
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Saiki C, Ferrell B, Longo-Schoeberlein D, Chung V, Smith TJ. Goals-of-care discussions. ACTA ACUST UNITED AC 2017; 15:e190-e194. [PMID: 30148185 DOI: 10.12788/jcso.0355] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Goals-of-care conversations led by the oncologist are key to advancing the prognostic awareness of the patient and family, but too frequently do not occur or are ineffective in leading to advance care planning and appropriate planning for end-of-life care. At our institution, a phase 3 trial of palliative care added to usual care of phase 1 clinical trial patients gave us the opportunity to develop an electronic medical record-based goals-of-care template for discussions. We can complete all or parts of the form with patients, use it to ensure full coverage of important tasks such as planning for transition to hospice and legacy work, and make sure all the providers are "on the same page" about treatment plans. We have this within our EMR as a SmartPhrase that can be brought up for completion, and have found that it helps to clarify patient understanding. The form can also be used to document advance care planning for both clinical care and billing. Although this tool has not been formally tested, we have found that it is effective in day-to-day practice as well as in research, and we share it here.
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Affiliation(s)
- Catherine Saiki
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | | | | | | | - Thomas J Smith
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
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Sivendran S, Jenkins S, Svetec S, Horst M, Newport K, Yost KJ, Yang M. Illness Understanding of Oncology Patients in a Community-Based Cancer Institute. J Oncol Pract 2017; 13:e800-e808. [PMID: 28678589 DOI: 10.1200/jop.2017.020982] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
PURPOSE Several studies have demonstrated that patients have a poor understanding of prognosis, survival, and effectiveness of chemotherapy, particularly in the setting of advanced cancer. This study examines oncology patients' understanding of their illness based on accurate reporting of stage at diagnosis and knowledge of cancer status (ie, free of cancer or in remission v active disease). MATERIALS AND METHODS Two hundred eight patients with cancer previously treated at our large community-based cancer institute participated in the Consumer-Based Cancer Care Value Index field survey. Electronic medical record documentation of stage at diagnosis and cancer status was compared with patients' self-reported responses. Concordance of responses and variables influencing discordance were evaluated. RESULTS In 51.0% of patients, self-reported cancer stage matched the abstracted stage, with the highest concordance in patients with advanced cancer (72%) versus patients with stage I to III disease (36.4% to 61.5%). Unexpectedly, discordance was lower among patients with advanced cancer compared with patients with stage I to III cancer ( P = .0528). Patients who were concordant for cancer stage at diagnosis were significantly more likely to be female ( P = .001), be younger than age 65 years ( P = .01), have an income > $60,000 ( P = .03), and have more education ( P = .02). In 64.4% of patients, self-reported cancer status (ie, free of cancer or in remission v active disease) matched the abstracted status. Nearly 30% of patients were not sure about their status, even when they were free of cancer or in remission. CONCLUSION Our findings confirm that more than one quarter of patients with advanced cancer have poor illness understanding and highlight that an even greater number of patients with early stage I to III cancer have poor illness understanding. These observations highlight the need to improve illness understanding for patients across the entire cancer continuum.
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Affiliation(s)
- Shanthi Sivendran
- Penn Medicine at Lancaster General Health; Palliative Medicine Consultants, Lancaster, PA; Mayo Clinic, Rochester, MN; and American Institutes for Research, Chapel Hill, NC
| | - Sarah Jenkins
- Penn Medicine at Lancaster General Health; Palliative Medicine Consultants, Lancaster, PA; Mayo Clinic, Rochester, MN; and American Institutes for Research, Chapel Hill, NC
| | - Sarah Svetec
- Penn Medicine at Lancaster General Health; Palliative Medicine Consultants, Lancaster, PA; Mayo Clinic, Rochester, MN; and American Institutes for Research, Chapel Hill, NC
| | - Michael Horst
- Penn Medicine at Lancaster General Health; Palliative Medicine Consultants, Lancaster, PA; Mayo Clinic, Rochester, MN; and American Institutes for Research, Chapel Hill, NC
| | - Kristina Newport
- Penn Medicine at Lancaster General Health; Palliative Medicine Consultants, Lancaster, PA; Mayo Clinic, Rochester, MN; and American Institutes for Research, Chapel Hill, NC
| | - Kathleen J Yost
- Penn Medicine at Lancaster General Health; Palliative Medicine Consultants, Lancaster, PA; Mayo Clinic, Rochester, MN; and American Institutes for Research, Chapel Hill, NC
| | - Manshu Yang
- Penn Medicine at Lancaster General Health; Palliative Medicine Consultants, Lancaster, PA; Mayo Clinic, Rochester, MN; and American Institutes for Research, Chapel Hill, NC
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