title: A question prompt list for patients with advanced cancer in the final year of life: development and cross-cultural evaluation.
abstract: BACKGROUND
  Clinicians and patients find prognosis and end-of-life care discussions challenging. Misunderstanding one's prognosis can contribute to poor decision-making and end-of-life quality of life. A question prompt list (booklet of questions patients can ask clinicians) targeting these issues may help overcome communication barriers. None exists for end-of-life discussions outside the palliative care setting.
  
  
  OBJECTIVE
  To develop/pilot a question prompt list facilitating discussion/planning of end-of-life care for oncology patients with advanced cancer from Australia and the United States and to explore acceptability, perceived benefits/challenges of using the question prompt list, suggestions for improvements and the necessity of country-specific adaptations.
  
  
  METHODS
  An expert panel developed a question prompt list targeting prognosis and end-of-life issues. Australian/US semi-structured interviews and one focus group elicited feedback about the question prompt list. Transcribed data were analysed using qualitative methods.
  
  
  METHODS
  Thirty-four patients with advanced cancer (15 Australian/19 US) and 13 health professionals treating such patients (7 Australian/6 US) from two Australian and one US cancer centre participated.
  
  
  RESULTS
  Most endorsed the entire question prompt list, though a minority queried the utility/appropriateness of some questions. Analysis identified four global themes: (1) reinforcement of known benefits of question prompt lists, (2) appraisal of content and suggestions for further developments, (3) perceived benefits and challenges in using the question prompt list and (4) contrasts in Australian/US feedback. These contrasts necessitated distinct Australian/US final versions of the question prompt list.
  
  
  CONCLUSIONS
  Participants endorsed the question prompt list as acceptable and useful. Feedback resulted in two distinct versions of the question prompt list, accommodating differences between Australian and US approaches to end-of-life discussions, highlighting the appropriateness of tailoring communication aides to individual populations.
authors: School of Psychology, University of Sydney, Sydney, NSW, Australia. adam.walczak@sydney.edu.au
authors: Adam
authors: A
authors: Walczak
authors: Benjamin
authors: B
authors: Mazer
authors: Phyllis N
authors: PN
authors: Butow
authors: Martin H N
authors: MH
authors: Tattersall
authors: Josephine M
authors: JM
authors: Clayton
authors: Patricia M
authors: PM
authors: Davidson
authors: Jane
authors: J
authors: Young
authors: Susan
authors: S
authors: Ladwig
authors: Ronald M
authors: RM
authors: Epstein
mesh_terms: D032722:Advance Care Planning; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D003144:Communication Barriers; D003431:Cross-Cultural Comparison; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D010166:Palliative Care; D010358:Patient Participation; D010817:Physician-Patient Relations; D011379:Prognosis; D036301:Qualitative Research; D017010:Reminder Systems / Q000295:instrumentation*; D014481:United States
keywords: Question prompt list; advanced cancer; communication; cross-cultural comparison; qualitative research; terminal care