This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Clayton, J. M. Articles by Noel, M. A. Search for Related Content PubMed PubMed Citation Articles by Clayton, J. M. Articles by Noel, M. A. Social Bookmarking                            What's this?

Randomized Controlled Trial of a Prompt List to Help Advanced Cancer Patients and Their Caregivers to Ask Questions About Prognosis and End-of-Life Care

Josephine M. Clayton, Phyllis N. Butow, Martin H.N. Tattersall, Rhonda J. Devine, Judy M. Simpson, Ghauri Aggarwal, Katherine J. Clark, David C. Currow, Louise M. Elliott, Judith Lacey, Philip G. Lee, Michael A. Noel

From the Medical Psychology Research Unit, Department of Medicine and School of Psychology, and the School of Public Health, University of Sydney; Sacred Heart, Concord, Royal Prince Alfred, Liverpool, Calvary, Westmead, and Nepean Hospital Palliative Care Services, Sydney, New South Wales; and Southern Adelaide Palliative Services, Adelaide, South Australia, Australia

Address reprint requests to Josephine Clayton, FRACP, PhD, Medical Psychology Research Unit, Blackburn Building D06, University of Sydney, New South Wales 2006, Australia; e-mail: jclayton{at}med.usyd.edu.au

PURPOSE: To determine whether provision of a question prompt list (QPL) influences advanced cancer patients’/caregivers’ questions and discussion of topics relevant to end-of-life care during consultations with a palliative care (PC) physician.

PATIENTS AND METHODS: This randomized controlled trial included patients randomly assigned to standard consultation or provision of QPL before consultation, with endorsement of the QPL by the physician during the consultation. Consecutive eligible patients with advanced cancer referred to 15 PC physicians from nine Australian PC services were invited to participate. Consultations were audiotaped, transcribed, and analyzed by blinded coders; patients completed questionnaires before, within 24 hours, and 3 weeks after the consultation.

RESULTS: A total of 174 patients participated (92 QPL, 82 control). Compared with controls, QPL patients and caregivers asked twice as many questions (for patients, ratio, 2.3; 95% CI, 1.7 to 3.2; P < .0001), and patients discussed 23% more issues covered by the QPL (95% CI, 11% to 37%; P < .0001). QPL patients asked more prognostic questions (ratio, 2.3; 95% CI, 1.3 to 4.0; P = .004) and discussed more prognostic (ratio, 1.43; 95% CI, 1.1 to 1.8, P = .003) and end-of-life issues (30% v 10%; P = .001). Fewer QPL patients had unmet information needs about the future (²₁ = 4.14; P = .04), which was the area of greatest unmet information need. QPL consultations (average, 38 minutes) were longer (P = .002) than controls (average, 31 minutes). No differences between groups were observed in anxiety or patient/physician satisfaction.

CONCLUSION: Providing a QPL and physician endorsement of its use assists terminally ill cancer patients and their caregivers to ask questions and promotes discussion about prognosis and end-of-life issues, without creating patient anxiety or impairing satisfaction.

Supported by an Australian National Health and Medical Research Council Medical Postgraduate Scholarship and a Career Development and Support Fellowship from the Cancer Institute, New South Wales, Australia (J.M.C.).

Presented in part at the 8th Australian Palliative Care Conference, August 30-September 2, 2005, Sydney, Australia; and the Clinical Oncological Society of Australia 32nd Annual Scientific Meeting, November 16-18, 2005, Brisbane, Australia.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				L. Selman, I. J Higginson, G. Agupio, N. Dinat, J. Downing, L. Gwyther, T. Mashao, K. Mmoledi, A. P Moll, L. M. Sebuyira, et al. Meeting information needs of patients with incurable progressive disease and their families in South Africa and Uganda: multicentre qualitative study BMJ, April 22, 2009; 338(apr22_1): b1326 - b1326. [Abstract] [Full Text] [PDF]

				R.S. Hebert, R. Schulz, V.C. Copeland, and R.M. Arnold Pilot Testing of a Question Prompt Sheet to Encourage Family Caregivers of Cancer Patients and Physicians to Discuss End-of-life Issues American Journal of Hospice and Palliative Medicine, February 1, 2009; 26(1): 24 - 32. [Abstract] [PDF]

				D. Stacey, R. Samant, and C. Bennett Decision Making in Oncology: A Review of Patient Decision Aids to Support Patient Participation CA Cancer J Clin, September 1, 2008; 58(5): 293 - 304. [Abstract] [Full Text] [PDF]

				S. Gabrijel, L. Grize, E. Helfenstein, M. Brutsche, P. Grossman, M. Tamm, and A. Kiss Receiving the Diagnosis of Lung Cancer: Patient Recall of Information and Satisfaction With Physician Communication J. Clin. Oncol., January 10, 2008; 26(2): 297 - 302. [Abstract] [Full Text] [PDF]