Communication with patients with limited prognosis-an integrative mixed-methods evaluation study.
Communication
Lung cancer
Mixed methods
Palliative medicine
Prognosis
Terminal illness
Journal
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
ISSN: 1433-7339
Titre abrégé: Support Care Cancer
Pays: Germany
ID NLM: 9302957
Informations de publication
Date de publication:
22 Dec 2022
22 Dec 2022
Historique:
received:
27
06
2022
accepted:
25
11
2022
entrez:
22
12
2022
pubmed:
23
12
2022
medline:
27
12
2022
Statut:
epublish
Résumé
Oncological societies advocate the continuity of care, specialized communication, and early integration of palliative care. To comply with these recommendations, an interprofessional, longitudinally-structured communication concept, the Milestone Communication Approach (MCA), was previously developed, implemented, and evaluated. Our research question is: what are possible explanations from the patient perspective for prognosis and advance care planning being rarely a topic and for finding no differences between MCA and control groups concerning distress, quality of life, and mood? A pragmatic epistemological stance guided the study. A mixed-methods design was chosen including a pragmatic randomized trial (n = 171), qualitative interviews with patients (n = 13) and caregivers (n = 12), and a content analysis (133 milestone conversations, 54 follow-up calls). Data analysis involved the pillar integration process. Two pillar themes emerged: 1 "approaching prognosis and advance care planning"; 2 "living with a life-threatening illness". Information on prognosis seemed to be offered, but patients' reactions were diverse. Some patients have to deal with having advanced lung cancer while nonetheless feeling healthy and seem not to be ready for prognostic information. All patients seemed to struggle to preserve their quality of life and keep distress under control. Attending to patients' questions, worries and needs early in a disease trajectory seems key to helping patients adjust to living with lung cancer. If necessary clinicians should name their predicament: having to inform about prognosis versus respecting the patients wish to avoid it. Research should support better understanding of patients not wishing for prognostic information to successfully improve communication strategies. Registration: German Clinical Trial Register No. DRKS00013649, registration date 12/22/2017, ( https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00013649 ) and No. DRKS00013469, registration date 12/22/2017, ( https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00013469 ).
Identifiants
pubmed: 36547732
doi: 10.1007/s00520-022-07474-9
pii: 10.1007/s00520-022-07474-9
pmc: PMC9780125
doi:
Types de publication
Journal Article
Pragmatic Clinical Trial
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
77Subventions
Organisme : German National Center for Tumor diseases
ID : NCT 3.0, G835
Organisme : German National Center for Tumor diseases
ID : NCT 3.0, G835
Organisme : German National Center for Tumor diseases
ID : NCT 3.0, G835
Organisme : German Federal Ministry for Health
ID : No. 1504-54401
Organisme : German Federal Ministry for Health
ID : No. 1504-54401
Organisme : German Federal Ministry for Health
ID : No. 1504-54401
Organisme : German Federal Ministry for Health
ID : No. 1504-54401
Organisme : German Federal Ministry for Health
ID : No. 1504-54401
Informations de copyright
© 2022. The Author(s).
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