Randomized controlled trial of a prompt list to help advanced cancer patients and their caregivers to ask questions about prognosis and end-of-life care.
OBJECTIVE
To determine whether provision of a question prompt list (QPL) influences advanced cancer patients'/caregivers' questions and discussion of topics relevant to end-of-life care during consultations with a palliative care (PC) physician.


METHODS
This randomized controlled trial included patients randomly assigned to standard consultation or provision of QPL before consultation, with endorsement of the QPL by the physician during the consultation. Consecutive eligible patients with advanced cancer referred to 15 PC physicians from nine Australian PC services were invited to participate. Consultations were audiotaped, transcribed, and analyzed by blinded coders; patients completed questionnaires before, within 24 hours, and 3 weeks after the consultation.


RESULTS
A total of 174 patients participated (92 QPL, 82 control). Compared with controls, QPL patients and caregivers asked twice as many questions (for patients, ratio, 2.3; 95% CI, 1.7 to 3.2; P < .0001), and patients discussed 23% more issues covered by the QPL (95% CI, 11% to 37%; P < .0001). QPL patients asked more prognostic questions (ratio, 2.3; 95% CI, 1.3 to 4.0; P = .004) and discussed more prognostic (ratio, 1.43; 95% CI, 1.1 to 1.8, P = .003) and end-of-life issues (30% v 10%; P = .001). Fewer QPL patients had unmet information needs about the future (21 = 4.14; P = .04), which was the area of greatest unmet information need. QPL consultations (average, 38 minutes) were longer (P = .002) than controls (average, 31 minutes). No differences between groups were observed in anxiety or patient/physician satisfaction.


CONCLUSIONS
Providing a QPL and physician endorsement of its use assists terminally ill cancer patients and their caregivers to ask questions and promotes discussion about prognosis and end-of-life issues, without creating patient anxiety or impairing satisfaction.
Clayton
Josephine M
JM
Medical Psychology Research Unit, Department of Medicine and School of Psychology, and the School of Public Health, University of Sydney, New South Wales, Australia. jclayton@med.usyd.edu.au
Butow
Phyllis N
PN
Tattersall
Martin H N
MH
Devine
Rhonda J
RJ
Simpson
Judy M
JM
Aggarwal
Ghauri
G
Clark
Katherine J
KJ
Currow
David C
DC
Elliott
Louise M
LM
Lacey
Judith
J
Lee
Philip G
PG
Noel
Michael A
MA
D000328:Adult; D032722:Advance Care Planning; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D017028:Caregivers; D003142:Communication; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D015588:Observer Variation; D010166:Palliative Care; D010358:Patient Participation; D010817:Physician-Patient Relations; D011379:Prognosis; D012017:Referral and Consultation; D017010:Reminder Systems / Q000295:instrumentation; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000458:organization & administration*; D019452:Terminally Ill