title: Communication about standard treatment options and clinical trials: can we teach doctors new skills to improve patient outcomes?
abstract: BACKGROUND
  The International Breast Cancer Study Group conducted a phase III trial in Australian/New Zealand (ANZ) and Swiss/German/Austrian (SGA) centres on training doctors in clear and ethical information delivery about treatment options and strategies to encourage shared decision making.
  
  
  METHODS
  Medical, surgical, gynaecological and radiation oncologists, and their patients for whom adjuvant breast cancer therapy was indicated, were eligible. Doctors were randomised to participate in a workshop with standardised teaching material and role playing. Patients were recruited in the experimental and control groups before and after the workshop.
  
  
  RESULTS
  In ANZ centres, 21 eligible doctors recruited a total of 304 assessable patients. In SGA centres, 41 doctors recruited 390 patients. The training was well accepted. There was no overall effect on patient decisional conflict (primary endpoint) 2 weeks after the consultation. Overall, patients were satisfied with their treatment decision, their consultation and their doctors' consultation skills. Considerable variation was observed in patient outcomes between SGA and ANZ centres; the effect sizes of the intervention were marginal (<0.2).
  
  
  CONCLUSIONS
  Shared decision making remains a challenge. A sustained training effect may require more intensive training tailored to the local setting. Cross-cultural differences need attention in conducting trials on communication interventions.
authors.affiliation: IBCSG Coordinating Center, Effingerstrasse 40, 3008, Bern, Switzerland. juerg.bernhard@ibcsg.org
authors.forename: Jürg
authors.initials: J
authors.lastname: Bernhard
authors.forename: Phyllis
authors.initials: P
authors.lastname: Butow
authors.forename: Julie
authors.initials: J
authors.lastname: Aldridge
authors.forename: Ilona
authors.initials: I
authors.lastname: Juraskova
authors.forename: Karin
authors.initials: K
authors.lastname: Ribi
authors.forename: Richard
authors.initials: R
authors.lastname: Brown
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001315:Australia; D001943:Breast Neoplasms / Q000523:psychology / Q000628:therapy*; D003131:Combined Modality Therapy; D003142:Communication; D003431:Cross-Cultural Comparison; D003657:Decision Making; D004502:Education, Medical, Continuing; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D009520:New Zealand; D010043:Outcome and Process Assessment, Health Care; D010358:Patient Participation; D017060:Patient Satisfaction; D016544:Patient Simulation; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology; D011795:Surveys and Questionnaires