title: Speaking Up: How Patient and Physician Voices Shaped a Trial to Improve Goals-of-Care Discussions.
abstract: Patients with advanced cancer benefit from early goals-of-care (GoC) conversations, but few facilitators are known.
  
  
  
  We describe the process and outcomes of involving patient and physician stakeholders in the design and development of a trial, funded by the Patient-Centered Outcomes Research Institute (PCORI), to enhance oncologists' communication skills and their propensity to facilitate productive, meaningful GoC discussions with patients with advanced cancer.
  
  
  
  We recruited oncologists, palliative care physicians, and patient stakeholders to participate in proposal development, intervention design and modification, identification of outcome measures, and refinement of study tools. Formats for exchange included 1:1 structured interviews, workshops, and stakeholder meetings.
  
  
  
  Patient and physician voices helped craft and implement a study of an intervention to enhance oncologists' ability to facilitate GoC discussions with patients with advanced cancer. Physician inputs guided the creation of an oncologist and palliative care physician "joint visit" intervention at a turning point in disease management. Patient inputs impacted on the language used, outcome measures assessed, and approaches used to introduce patients to the intervention visit.
  
  
  
  Stakeholder input informed the development of a novel intervention that physicians seemed to find both valuable and in sync with their needs and their practice schedules. Where communication about difficult subjects and shared decision making are involved, including multiple stakeholder groups in study design, implementation, and outcomes measurement may have far-reaching effects.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA. Rachel.Solomon@mountsinai.org.
authors.forename: Rachel
authors.initials: R
authors.lastname: Solomon
authors.affiliation: Division of Hematology/Medical Oncology, Department of Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1079, New York, NY, 10029, USA.|Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1079, New York, NY, 10029, USA.
authors.forename: Cardinale
authors.initials: C
authors.lastname: Smith
authors.affiliation: , New York, NY, USA.
authors.forename: Jay
authors.initials: J
authors.lastname: Kallio
authors.affiliation: , New Haven, CT, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Fenollosa
authors.affiliation: , New York, NY, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Benerofe
authors.affiliation: , New York, NY, USA.
authors.forename: Laurence
authors.initials: L
authors.lastname: Jones
authors.affiliation: Yale University School of Medicine, Smilow Cancer Hospital at Yale New Haven, 35 Park Street, North Pavillion 15, Suite 3006, New Haven, CT, 06510, USA.
authors.forename: Kerin
authors.initials: K
authors.lastname: Adelson
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Kings County Hospital Center, SUNY Downstate Medical School, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA.
authors.forename: Jason P
authors.initials: JP
authors.lastname: Gonsky
authors.affiliation: CancerCare, 275 7th Ave, New York, NY, 10001, USA.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Messner
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA.|Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA.
authors.forename: Nina A
authors.initials: NA
authors.lastname: Bickell
mesh_terms: D000328:Adult; D000368:Aged; D003142:Communication; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy; D010166:Palliative Care / Q000458:organization & administration; D010347:Patient Care Planning / Q000458:organization & administration*; D010358:Patient Participation / Q000379:methods*; D010817:Physician-Patient Relations; D010820:Physicians; D012107:Research Design