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Cancer Consultation Preparation Package: Changing Patients but Not Physicians Is Not Enough

From the Medical Psychology Research Unit, School of Psychology/Department of Cancer Medicine, University of Sydney; Departments of Medical Oncology and Radiation Oncology, Royal Prince Alfred Hospital, Sydney, Australia

Address reprint requests to Phyllis Butow, PhD, Medical Psychology Research Unit, University of Sydney, Sydney, NSW 2006, Australia; e-mail: phyllisb{at}med.usyd.edu.au

PURPOSE: This study evaluated a cancer consultation preparation package (CCPP) designed to facilitate patient involvement in the oncology consultation.

PATIENTS AND METHODS: A total of 164 cancer patients (67% response rate) were randomly assigned to receive the CCPP or a control booklet at least 48 hours before their first oncology appointment. The CCPP included a question prompt sheet, booklets on clinical decision making and patient rights, and an introduction to the clinic. The control booklet contained only the introduction to the clinic. Physicians were blinded to which intervention patients received. Patients completed questionnaires immediately after the consultation and 1 month later. Consultations were audiotaped, transcribed verbatim, and coded.

RESULTS: All but one patient read the information. Before the consultation, intervention patients were significantly more anxious than were controls (mean, 42 v 38; P = .04); however anxiety was equivalent at follow-up. The CCPP was reported as being significantly more useful to family members than the control booklet (P = .004). Patients receiving the intervention asked significantly more questions (11 v seven questions; P = .005), tended to interrupt the physician more (1.01 v 0.71 interruptions; P = .08), and challenged information significantly more often (twice v once; P = .05). Patients receiving the CCPP were less likely to achieve their preferred decision making style (22%) than were controls (35%; P = .06).

CONCLUSION: This CCPP influences patients' consultation behavior and does not increase anxiety in the long-term. However, this intervention, without physician endorsement, reduced the percentage of patients whose preferred involvement in decision making was achieved.

Supported by the National Health and Medical Research Council of Australia.

Presented in poster form at the 39th Annual Meeting of the American Society of Clinical Oncology, Chicago, IL, May 31-June 3, 2003, and at the Clinical Oncology Society of Australia meeting, Sydney, Australia, November 28-30, 2002.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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