title: Promoting End-of-Life Discussions in Advanced Cancer: Effects of Patient Coaching and Question Prompt Lists.
abstract: Purpose To build on results of a cluster randomized controlled trial (RCT) of a combined patient-oncologist intervention to improve communication in advanced cancer, we conducted a post hoc analysis of the patient intervention component, a previsit patient coaching session that used a question prompt list (QPL). We hypothesized that intervention-group participants would bring up more QPL-related topics, particularly prognosis-related topics, during the subsequent oncologist visit. Patients and Methods This cluster RCT with 170 patients who had advanced nonhematologic cancer (and their caregivers) recruited from practices of 24 participating oncologists in western New York. Intervention-group oncologists (n = 12) received individualized communication training; up to 10 of their patients (n = 84) received a previsit individualized communication coaching session that incorporated a QPL. Control-group oncologists (n = 12) and patients (n = 86) received no interventions. Topics of interest identified by patients during the coaching session were summarized from coaching notes; one office visit after the coaching session was audio recorded, transcribed, and analyzed by using linear regression modeling for group differences. Results Compared with controls, more than twice as many intervention-group participants brought up QPL-related topics during their office visits (70.2% v 32.6%; P < .001). Patients in the intervention group were nearly three times more likely to ask about prognosis (16.7% v 5.8%; P =.03). Of 262 topics of interest identified during coaching, 158 (60.3%) were QPL related; 20 (12.7%) addressed prognosis. Overall, patients in the intervention group brought up 82.4% of topics of interest during the office visit. Conclusion A combined coaching and QPL intervention was effective to help patients with advanced cancer and their caregivers identify and bring up topics of concern, including prognosis, during their subsequent oncologist visits. Considering that most patients are misinformed about prognosis, more intensive steps are needed to better promote such discussions.
authors.affiliation: Rachel A. Rodenbach, Kevin Fiscella, Paul R. Duberstein, Peter Sullivan, Beth Hoh, Sandy Plumb, and Ronald M. Epstein, Center for Communication and Disparities Research; Rachel A. Rodenbach and Ronald M. Epstein, University of Rochester School of Medicine and Dentistry; Kevin Fiscella and Paul R. Duberstein, University of Rochester Medical Center, Rochester, NY; Rachel A. Rodenbach, University of Pittsburgh Medical Center, Pittsburgh, PA; Kim Brandes, University of Amsterdam, Amsterdam, the Netherlands; Richard L. Kravitz and Guibo Xing, University of California Davis, Sacramento, CA; and Phyllis N. Butow and Adam Walczak, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Rodenbach
authors.affiliation: Rachel A. Rodenbach, Kevin Fiscella, Paul R. Duberstein, Peter Sullivan, Beth Hoh, Sandy Plumb, and Ronald M. Epstein, Center for Communication and Disparities Research; Rachel A. Rodenbach and Ronald M. Epstein, University of Rochester School of Medicine and Dentistry; Kevin Fiscella and Paul R. Duberstein, University of Rochester Medical Center, Rochester, NY; Rachel A. Rodenbach, University of Pittsburgh Medical Center, Pittsburgh, PA; Kim Brandes, University of Amsterdam, Amsterdam, the Netherlands; Richard L. Kravitz and Guibo Xing, University of California Davis, Sacramento, CA; and Phyllis N. Butow and Adam Walczak, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Kim
authors.initials: K
authors.lastname: Brandes
authors.affiliation: Rachel A. Rodenbach, Kevin Fiscella, Paul R. Duberstein, Peter Sullivan, Beth Hoh, Sandy Plumb, and Ronald M. Epstein, Center for Communication and Disparities Research; Rachel A. Rodenbach and Ronald M. Epstein, University of Rochester School of Medicine and Dentistry; Kevin Fiscella and Paul R. Duberstein, University of Rochester Medical Center, Rochester, NY; Rachel A. Rodenbach, University of Pittsburgh Medical Center, Pittsburgh, PA; Kim Brandes, University of Amsterdam, Amsterdam, the Netherlands; Richard L. Kravitz and Guibo Xing, University of California Davis, Sacramento, CA; and Phyllis N. Butow and Adam Walczak, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Kevin
authors.initials: K
authors.lastname: Fiscella
authors.affiliation: Rachel A. Rodenbach, Kevin Fiscella, Paul R. Duberstein, Peter Sullivan, Beth Hoh, Sandy Plumb, and Ronald M. Epstein, Center for Communication and Disparities Research; Rachel A. Rodenbach and Ronald M. Epstein, University of Rochester School of Medicine and Dentistry; Kevin Fiscella and Paul R. Duberstein, University of Rochester Medical Center, Rochester, NY; Rachel A. Rodenbach, University of Pittsburgh Medical Center, Pittsburgh, PA; Kim Brandes, University of Amsterdam, Amsterdam, the Netherlands; Richard L. Kravitz and Guibo Xing, University of California Davis, Sacramento, CA; and Phyllis N. Butow and Adam Walczak, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Kravitz
authors.affiliation: Rachel A. Rodenbach, Kevin Fiscella, Paul R. Duberstein, Peter Sullivan, Beth Hoh, Sandy Plumb, and Ronald M. Epstein, Center for Communication and Disparities Research; Rachel A. Rodenbach and Ronald M. Epstein, University of Rochester School of Medicine and Dentistry; Kevin Fiscella and Paul R. Duberstein, University of Rochester Medical Center, Rochester, NY; Rachel A. Rodenbach, University of Pittsburgh Medical Center, Pittsburgh, PA; Kim Brandes, University of Amsterdam, Amsterdam, the Netherlands; Richard L. Kravitz and Guibo Xing, University of California Davis, Sacramento, CA; and Phyllis N. Butow and Adam Walczak, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Phyllis N
authors.initials: PN
authors.lastname: Butow
authors.affiliation: Rachel A. Rodenbach, Kevin Fiscella, Paul R. Duberstein, Peter Sullivan, Beth Hoh, Sandy Plumb, and Ronald M. Epstein, Center for Communication and Disparities Research; Rachel A. Rodenbach and Ronald M. Epstein, University of Rochester School of Medicine and Dentistry; Kevin Fiscella and Paul R. Duberstein, University of Rochester Medical Center, Rochester, NY; Rachel A. Rodenbach, University of Pittsburgh Medical Center, Pittsburgh, PA; Kim Brandes, University of Amsterdam, Amsterdam, the Netherlands; Richard L. Kravitz and Guibo Xing, University of California Davis, Sacramento, CA; and Phyllis N. Butow and Adam Walczak, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Adam
authors.initials: A
authors.lastname: Walczak
authors.affiliation: Rachel A. Rodenbach, Kevin Fiscella, Paul R. Duberstein, Peter Sullivan, Beth Hoh, Sandy Plumb, and Ronald M. Epstein, Center for Communication and Disparities Research; Rachel A. Rodenbach and Ronald M. Epstein, University of Rochester School of Medicine and Dentistry; Kevin Fiscella and Paul R. Duberstein, University of Rochester Medical Center, Rochester, NY; Rachel A. Rodenbach, University of Pittsburgh Medical Center, Pittsburgh, PA; Kim Brandes, University of Amsterdam, Amsterdam, the Netherlands; Richard L. Kravitz and Guibo Xing, University of California Davis, Sacramento, CA; and Phyllis N. Butow and Adam Walczak, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Duberstein
authors.affiliation: Rachel A. Rodenbach, Kevin Fiscella, Paul R. Duberstein, Peter Sullivan, Beth Hoh, Sandy Plumb, and Ronald M. Epstein, Center for Communication and Disparities Research; Rachel A. Rodenbach and Ronald M. Epstein, University of Rochester School of Medicine and Dentistry; Kevin Fiscella and Paul R. Duberstein, University of Rochester Medical Center, Rochester, NY; Rachel A. Rodenbach, University of Pittsburgh Medical Center, Pittsburgh, PA; Kim Brandes, University of Amsterdam, Amsterdam, the Netherlands; Richard L. Kravitz and Guibo Xing, University of California Davis, Sacramento, CA; and Phyllis N. Butow and Adam Walczak, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Sullivan
authors.affiliation: Rachel A. Rodenbach, Kevin Fiscella, Paul R. Duberstein, Peter Sullivan, Beth Hoh, Sandy Plumb, and Ronald M. Epstein, Center for Communication and Disparities Research; Rachel A. Rodenbach and Ronald M. Epstein, University of Rochester School of Medicine and Dentistry; Kevin Fiscella and Paul R. Duberstein, University of Rochester Medical Center, Rochester, NY; Rachel A. Rodenbach, University of Pittsburgh Medical Center, Pittsburgh, PA; Kim Brandes, University of Amsterdam, Amsterdam, the Netherlands; Richard L. Kravitz and Guibo Xing, University of California Davis, Sacramento, CA; and Phyllis N. Butow and Adam Walczak, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Beth
authors.initials: B
authors.lastname: Hoh
authors.affiliation: Rachel A. Rodenbach, Kevin Fiscella, Paul R. Duberstein, Peter Sullivan, Beth Hoh, Sandy Plumb, and Ronald M. Epstein, Center for Communication and Disparities Research; Rachel A. Rodenbach and Ronald M. Epstein, University of Rochester School of Medicine and Dentistry; Kevin Fiscella and Paul R. Duberstein, University of Rochester Medical Center, Rochester, NY; Rachel A. Rodenbach, University of Pittsburgh Medical Center, Pittsburgh, PA; Kim Brandes, University of Amsterdam, Amsterdam, the Netherlands; Richard L. Kravitz and Guibo Xing, University of California Davis, Sacramento, CA; and Phyllis N. Butow and Adam Walczak, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Guibo
authors.initials: G
authors.lastname: Xing
authors.affiliation: Rachel A. Rodenbach, Kevin Fiscella, Paul R. Duberstein, Peter Sullivan, Beth Hoh, Sandy Plumb, and Ronald M. Epstein, Center for Communication and Disparities Research; Rachel A. Rodenbach and Ronald M. Epstein, University of Rochester School of Medicine and Dentistry; Kevin Fiscella and Paul R. Duberstein, University of Rochester Medical Center, Rochester, NY; Rachel A. Rodenbach, University of Pittsburgh Medical Center, Pittsburgh, PA; Kim Brandes, University of Amsterdam, Amsterdam, the Netherlands; Richard L. Kravitz and Guibo Xing, University of California Davis, Sacramento, CA; and Phyllis N. Butow and Adam Walczak, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Sandy
authors.initials: S
authors.lastname: Plumb
authors.affiliation: Rachel A. Rodenbach, Kevin Fiscella, Paul R. Duberstein, Peter Sullivan, Beth Hoh, Sandy Plumb, and Ronald M. Epstein, Center for Communication and Disparities Research; Rachel A. Rodenbach and Ronald M. Epstein, University of Rochester School of Medicine and Dentistry; Kevin Fiscella and Paul R. Duberstein, University of Rochester Medical Center, Rochester, NY; Rachel A. Rodenbach, University of Pittsburgh Medical Center, Pittsburgh, PA; Kim Brandes, University of Amsterdam, Amsterdam, the Netherlands; Richard L. Kravitz and Guibo Xing, University of California Davis, Sacramento, CA; and Phyllis N. Butow and Adam Walczak, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Epstein
mesh_terms: D000328:Adult; D032722:Advance Care Planning; D000368:Aged; D001293:Attitude to Death; D003142:Communication; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy*; D000072103:Oncologists / Q000523:psychology*; D010817:Physician-Patient Relations; D013727:Terminal Care / Q000379:methods* / Q000523:psychology*