Patient and clinician experience of a serious illness conversation guide in oncology: A descriptive analysis.
advance care planning
advanced cancer
clinician experience
goals of care communication
palliative care
patient experience
prognostic communication
serious illness communication
Journal
Cancer medicine
ISSN: 2045-7634
Titre abrégé: Cancer Med
Pays: United States
ID NLM: 101595310
Informations de publication
Date de publication:
07 2020
07 2020
Historique:
received:
19
03
2020
accepted:
10
04
2020
pubmed:
5
5
2020
medline:
4
5
2021
entrez:
5
5
2020
Statut:
ppublish
Résumé
Oncology guidelines recommend earlier communication with patients about prognosis and goals-of-care in serious illness. However, current evidence leaves gaps in our understanding of the experience of these conversations. This analysis evaluates the patient and clinician experience of a conversation using a Serious Illness Conversation Guide (SICG). Secondary analysis from a cluster-randomized clinical trial in a northeastern cancer center. Physicians, advanced practice clinicians, and patients with advanced cancer who received the intervention. SICG, clinician training, systems-changes. The patient questionnaire assessed perceptions of the conversation and impact on anxiety, hopefulness, peacefulness, sense of control over medical decisions, closeness with their clinician, and behaviors. The clinician questionnaire assessed feasibility, acceptability, and impact on satisfaction in their role. We enrolled 54 clinicians and 163 patients; 41 clinicians and 118 patients had a SICG discussion. Most patients described the conversation as worthwhile (79%) and reported no change or improvement in their sense of peacefulness, hopefulness, and anxiety (on average 79%); 56% reported feeling closer with their clinician. Qualitative patient data described positive behavior changes, including enhanced planning for future care and increased focus on personal priorities. Nearly 90% of clinicians agreed that the SICG facilitated timely, effective conversations, and 70% reported increased satisfaction in their role. Conversations using a SICG were feasible, acceptable, and were associated with positive experiences for both patients and clinicians in oncology in ways that align with national recommendations for serious illness communication. This trial is registered at ClinicalTrials.gov: NCT01786811 https://clinicaltrials.gov/ct2/show/NCT01786811.
Sections du résumé
BACKGROUND/OBJECTIVE
Oncology guidelines recommend earlier communication with patients about prognosis and goals-of-care in serious illness. However, current evidence leaves gaps in our understanding of the experience of these conversations. This analysis evaluates the patient and clinician experience of a conversation using a Serious Illness Conversation Guide (SICG).
DESIGN/SETTING
Secondary analysis from a cluster-randomized clinical trial in a northeastern cancer center.
PARTICIPANTS
Physicians, advanced practice clinicians, and patients with advanced cancer who received the intervention.
INTERVENTION
SICG, clinician training, systems-changes.
MAIN OUTCOMES AND MEASURES
The patient questionnaire assessed perceptions of the conversation and impact on anxiety, hopefulness, peacefulness, sense of control over medical decisions, closeness with their clinician, and behaviors. The clinician questionnaire assessed feasibility, acceptability, and impact on satisfaction in their role.
RESULTS
We enrolled 54 clinicians and 163 patients; 41 clinicians and 118 patients had a SICG discussion. Most patients described the conversation as worthwhile (79%) and reported no change or improvement in their sense of peacefulness, hopefulness, and anxiety (on average 79%); 56% reported feeling closer with their clinician. Qualitative patient data described positive behavior changes, including enhanced planning for future care and increased focus on personal priorities. Nearly 90% of clinicians agreed that the SICG facilitated timely, effective conversations, and 70% reported increased satisfaction in their role.
CONCLUSION
Conversations using a SICG were feasible, acceptable, and were associated with positive experiences for both patients and clinicians in oncology in ways that align with national recommendations for serious illness communication. This trial is registered at ClinicalTrials.gov: NCT01786811 https://clinicaltrials.gov/ct2/show/NCT01786811.
Identifiants
pubmed: 32363775
doi: 10.1002/cam4.3102
pmc: PMC7333843
doi:
Banques de données
ClinicalTrials.gov
['NCT01786811']
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
4550-4560Informations de copyright
© 2020 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
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