Inge Henselmans1,2,3, Hanneke W M van Laarhoven4,3, Pomme van Maarschalkerweerd5, Hanneke C J M de Haes5, Marcel G W Dijkgraaf6, Dirkje W Sommeijer4,7, Petronella B Ottevanger8, Helle-Brit Fiebrich9, Serge Dohmen10, Geert-Jan Creemers11, Filip Y F L de Vos12, Ellen M A Smets5,2,3. 1. Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands i.henselmans@amc.uva.nl. 2. Amsterdam Public Health Research Institute, Amsterdam, The Netherlands. 3. Cancer Center Amsterdam, Amsterdam, The Netherlands. 4. Department of Medical Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands. 5. Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands. 6. Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands. 7. Department of Medical Oncology, Flevoziekenhuis, Almere, The Netherlands. 8. Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands. 9. Department of Medical Oncology, Isalaklinieken, Zwolle, The Netherlands. 10. Department of Medical Oncology, BovenIJZiekenhuis, Amsterdam, The Netherlands. 11. Department of Medical Oncology, Catharinaziekenhuis, Eindhoven, The Netherlands. 12. Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
Abstract
BACKGROUND: Palliative systematic treatment offers uncertain and often limited benefits, and the burden can be high. Hence, treatment decisions require shared decision making (SDM). This trial examined the independent and combined effect of an oncologist training and a patient communication aid on SDM. METHODS: In this multicenter randomized controlled trial with four parallel arms (2016-2018), oncologists (n = 31) were randomized to receive SDM communication skills training or not. The training consisted of a reader, two group sessions, a booster session, and a consultation room tool (10 hours). Patients (n = 194) with advanced cancer were randomized to receive a patient communication aid or not. The aid consisted of education on SDM, a question prompt list, and a value clarification exercise. The primary outcome was observed SDM as rated by blinded observers from audio-recorded consultations. Secondary outcomes included patient-reported SDM, patient and oncologist satisfaction, patients' decisional conflict, patient quality of life 3 months after consultation, consultation duration, and the decision made. RESULTS: The oncologist training had a large positive effect on observed SDM (Cohen's d = 1.12) and on patient-reported SDM (d = 0.73). The patient communication aid did not improve SDM. The combination of interventions did not add to the effect of training oncologists only. The interventions affected neither patient nor oncologist satisfaction with the consultation nor patients' decisional conflict, quality of life, consultation duration, or the decision made. CONCLUSION: Training medical oncologists in SDM about palliative systemic treatment improves both observed and patient-reported SDM. A patient communication aid does not. The incorporation of skills training in (continuing) educational programs for medical oncologists is likely to stimulate the widely advocated uptake of shared decision making in clinical practice. Trial registration. Netherlands Trial Registry NTR 5489. IMPLICATIONS FOR PRACTICE: Treatment for advanced cancer offers uncertain and often small benefits, and the burden can be high. Hence, treatment decisions require shared decision making (SDM). SDM is increasingly advocated for ethical reasons and for its beneficial effect on patient outcomes. Few initiatives to stimulate SDM are evaluated in robust designs. This randomized controlled trial shows that training medical oncologists improves both observed and patient-reported SDM in clinical encounters (n = 194). A preconsultation communication aid for patients did not add to the effect of training oncologists. SDM training effectively changes oncologists' practice and should be implemented in (continuing) educational programs.
RCT Entities:
BACKGROUND: Palliative systematic treatment offers uncertain and often limited benefits, and the burden can be high. Hence, treatment decisions require shared decision making (SDM). This trial examined the independent and combined effect of an oncologist training and a patient communication aid on SDM. METHODS: In this multicenter randomized controlled trial with four parallel arms (2016-2018), oncologists (n = 31) were randomized to receive SDM communication skills training or not. The training consisted of a reader, two group sessions, a booster session, and a consultation room tool (10 hours). Patients (n = 194) with advanced cancer were randomized to receive a patient communication aid or not. The aid consisted of education on SDM, a question prompt list, and a value clarification exercise. The primary outcome was observed SDM as rated by blinded observers from audio-recorded consultations. Secondary outcomes included patient-reported SDM, patient and oncologist satisfaction, patients' decisional conflict, patient quality of life 3 months after consultation, consultation duration, and the decision made. RESULTS: The oncologist training had a large positive effect on observed SDM (Cohen's d = 1.12) and on patient-reported SDM (d = 0.73). The patient communication aid did not improve SDM. The combination of interventions did not add to the effect of training oncologists only. The interventions affected neither patient nor oncologist satisfaction with the consultation nor patients' decisional conflict, quality of life, consultation duration, or the decision made. CONCLUSION: Training medical oncologists in SDM about palliative systemic treatment improves both observed and patient-reported SDM. A patient communication aid does not. The incorporation of skills training in (continuing) educational programs for medical oncologists is likely to stimulate the widely advocated uptake of shared decision making in clinical practice. Trial registration. Netherlands Trial Registry NTR 5489. IMPLICATIONS FOR PRACTICE: Treatment for advanced cancer offers uncertain and often small benefits, and the burden can be high. Hence, treatment decisions require shared decision making (SDM). SDM is increasingly advocated for ethical reasons and for its beneficial effect on patient outcomes. Few initiatives to stimulate SDM are evaluated in robust designs. This randomized controlled trial shows that training medical oncologists improves both observed and patient-reported SDM in clinical encounters (n = 194). A preconsultation communication aid for patients did not add to the effect of training oncologists. SDM training effectively changes oncologists' practice and should be implemented in (continuing) educational programs.
Authors: Valerie Fiset; Annette M. O'Connor; William Evans; Ian Graham; Catherine Degrasse; Jo Logan Journal: Health Expect Date: 2000-06 Impact factor: 3.377
Authors: Adam Walczak; Inge Henselmans; Martin H N Tattersall; Josephine M Clayton; Patricia M Davidson; Jane Young; Frances A Bellemore; Ronald M Epstein; Phyllis N Butow Journal: Psychooncology Date: 2014-07-30 Impact factor: 3.894
Authors: Sumayah Rodenburg-Vandenbussche; Arwen H Pieterse; Pieter M Kroonenberg; Isabelle Scholl; Trudy van der Weijden; Gre P M Luyten; Roy F P M Kruitwagen; Henk den Ouden; Ingrid V E Carlier; Irene M van Vliet; Frans G Zitman; Anne M Stiggelbout Journal: PLoS One Date: 2015-07-07 Impact factor: 3.240
Authors: Angela Fagerlin; Michael Pignone; Purva Abhyankar; Nananda Col; Deb Feldman-Stewart; Teresa Gavaruzzi; Jennifer Kryworuchko; Carrie A Levin; Arwen H Pieterse; Valerie Reyna; Anne Stiggelbout; Laura D Scherer; Celia Wills; Holly O Witteman Journal: BMC Med Inform Decis Mak Date: 2013-11-29 Impact factor: 2.796