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Intervention Improved Oncologist-Patient Communication, Not QOL or Hospice Use
Surabhi Dangi-Garimella, PhD

Intervention Improved Oncologist-Patient Communication, Not QOL or Hospice Use

Surabhi Dangi-Garimella, PhD
Paired communication training involving patients and oncologists achieves patient-centered care in advanced cancer.
To quantify the impact of patient-centered communication between an oncologist and a patient on the quality of care, patient’s quality of life (QOL), and the need for making informed decisions, a global interventional study was designed and conducted at centers across the United States and in Australia. The Values and Options in Cancer Care (VOICE) study evaluated the impact of 2 interventions on the outcomes listed above in patients with advanced cancer.

Participating oncologists, whose baseline communication patterns had been assessed, were randomized to receive individual communication training via patient instructors if they were in the intervention arm. Patients and their caregivers were randomized to receive an individualized coaching session with follow-up telephone calls. Participant enrollment was between August 2012 and June 2014, with follow-up through October 2015. Enrolled patients (265) were being treated for nonhematologic cancers (stage III or IV) and had a poorer prognosis. Inpatients and hospice patients were excluded. Patients agreed to an audio recording of their office visits and pre-visit and postvisit questionnaires. They were provided in-office physician training sessions (2) and a 1-hour patient and caregiver coaching session, and up to 3 follow-up phone calls. The training sessions focused on 4 main domains of patient-centered communication:
  • Disease course
  • Prognosis
  • Treatment decisions
  • End-of-life care
The primary outcome was a combination of patient-centered communication measured from audio recordings of the first visit after patient coaching or enrollment (control group). The trial also measured the following secondary outcomes: the patient–physician relationship, shared understanding of prognosis, QOL, and aggressive treatment and hospice use in the last 30 days of life.

The final analysis, with data from 38 oncologists and 265 patients, found that the interventional strategy resulted in clinically and statistically significant improvement in the primary physician–patient communication (adjusted intervention effect, 0.34; 95% CI, 0.06-0.62; P = .02). The authors write that paired communication training involving patients and oncologists achieves patient-centered care in advanced cancer by engaging patients in consultations, responding to their emotions, and providing information on prognosis and chosen treatments. Secondary outcomes were not influenced by the intervention. The authors explain that cancer patients reported stable QOL during the entire course of disease, up until the last few months.

Since the current intervention did not impact QOL, they discuss adjusting the timing of the intervention in future studies, hoping to impact QOL trajectories. The authors also suggest training office personnel to develop skill sets to coach patients to address logistical and methodological difficulties. Since healthcare utilization was the same between the 2 cohorts, the authors recommend addressing physician attributes and institutional norms in the context of aggressive interventions and hospice in patients with advanced cancer.

Epstein RM, Duberstein PR, Fenton JJ, et al. Effect of a patient-centered communication intervention on oncologist- patient communication, quality of life, and health care utilization in advanced cancer: the VOICE randomized clinical trial [published online September 9, 2016]. JAMA Oncol. doi: 10.1001/jamaoncol.2016.4373.
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