Sofya Pintova1, Ryan Leibrandt2, Cardinale B Smith1, Kerin B Adelson3, Jason Gonsky4, Natalia Egorova5, Rebeca Franco6, Nina A Bickell6. 1. Division of Hematology and Medical Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY. 2. Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY. 3. Smilow Cancer Hospital at Yale, New Haven, CT. 4. Division of Hematology and Medical Oncology, Department of Medicine, NYC Health and Hospitals/Kings County; and State University of New York Downstate Medical Center, Brooklyn, NY. 5. Department of Population Health Science and Policy at Mount Sinai, New York, NY. 6. Departments of Medicine and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
Abstract
PURPOSE: To describe the length of encounter during visits where goals-of-care (GoC) discussions were expected to take place. METHODS:Oncologists from community, academic, municipal, and rural hospitals were randomly assigned to receive a coaching model of communication skills to facilitate GoC discussionswith patients with newly diagnosed advanced solid-tumor cancer with a prognosis of < 2 years. Patients were surveyed after the first restaging visit regarding the quality of the GoC discussion on a scale of 0-10 (0 = worst; 10 = best), with ≥ 8 indicating a high-quality GoC discussion. Visits were audiotaped, and total encounter time was measured. RESULTS: The median face-to-face time oncologists spent during a GoC discussion was 15 minutes (range, 10-20 minutes). Among the different hospital types, there was no significant difference in encounter time. There was no difference in the length of the encounter whether a high-quality GoC discussion took place or not (15 v 14 minutes; P = .9). If there was imaging evidence of cancer progression, the median encounter time was 18 minutes compared with 13 minutes for no progression (P = .03). In a multivariate model, oncologist productivity, patient age, and Medicare coverage affected duration of the encounter. CONCLUSION: Oncologists can complete high-quality GoC discussions in 15 minutes. These data refute the common misperception that discussing such matters with patients with advanced cancer requires significant time.
RCT Entities:
PURPOSE: To describe the length of encounter during visits where goals-of-care (GoC) discussions were expected to take place. METHODS: Oncologists from community, academic, municipal, and rural hospitals were randomly assigned to receive a coaching model of communication skills to facilitate GoC discussions with patients with newly diagnosed advanced solid-tumor cancer with a prognosis of < 2 years. Patients were surveyed after the first restaging visit regarding the quality of the GoC discussion on a scale of 0-10 (0 = worst; 10 = best), with ≥ 8 indicating a high-quality GoC discussion. Visits were audiotaped, and total encounter time was measured. RESULTS: The median face-to-face time oncologists spent during a GoC discussion was 15 minutes (range, 10-20 minutes). Among the different hospital types, there was no significant difference in encounter time. There was no difference in the length of the encounter whether a high-quality GoC discussion took place or not (15 v 14 minutes; P = .9). If there was imaging evidence of cancer progression, the median encounter time was 18 minutes compared with 13 minutes for no progression (P = .03). In a multivariate model, oncologist productivity, patient age, and Medicare coverage affected duration of the encounter. CONCLUSION: Oncologists can complete high-quality GoC discussions in 15 minutes. These data refute the common misperception that discussing such matters with patients with advanced cancer requires significant time.
Authors: Andrew S Epstein; Michael Riley; Judith E Nelson; Camila Bernal; Steven Martin; Han Xiao Journal: Cancer Date: 2022-07-22 Impact factor: 6.921
Authors: Rebecca E Ryan; Michael Connolly; Natalie K Bradford; Simon Henderson; Anthony Herbert; Lina Schonfeld; Jeanine Young; Josephine I Bothroyd; Amanda Henderson Journal: Cochrane Database Syst Rev Date: 2022-07-08