None listed
Conditions
Brief summary
This study is aimed at evaluating a multifocal communication intervention incorporating a nurse-led patient and carer communication support program and and oncologist consultation skills training program. The intervention is intended to improve communication about life expectancy and end of life issues between patients with advanced incurable cancer, their carers and their oncologists in the final year of life.
Interventions
The multifocal communication intervention consists of two programs, one targeting the patient and their carer and another targeting the oncologist:
1) Patient and Carer Communication Support Program - consists of one face-to-face meeting (approx. 90 mins) and one telephone follow-up (approx. 30 mins) with a specially trained nurse.
- The face-to-face meeting will encourage the patient and carer to reflect on and discuss their goals, wishes, preferences and concerns about care into the future a
The multifocal communication intervention consists of two programs, one targeting the patient and their carer and another targeting the oncologist: 1) Patient and Carer Communication Support Program - consists of one face-to-face meeting (approx. 90 mins) and one telephone follow-up (approx. 30 mins) with a specially trained nurse. - The face-to-face meeting will encourage the patient and carer to reflect on and discuss their goals, wishes, preferences and concerns about care into the future and to discuss the challenges inherent in asking questions or communicating concerns with the patient's oncologist. They will also be guided through a new Question Prompt List targeting discussion of prognosis and end of life issues and assisted in selecting and prioritising any questions they may wish to ask in future consultations. Strategies to overcome barriers to asking these questions and to communication in the health care context in general will also be discussed. This face-to-face meeting will take place approximately 1 week prior to the audio-taped oncology consultation. - The telephone follow-up will review the patient's next oncology consultation after the face-to-face meeting with the nurse to identify any new barriers or challenges, discuss solutions to these and further assist in identifying and prioritising questions to ask at future consultations. It will be completed approximately 1 week after the audio-taped consultation. 2) Oncologist Consultation Skills Training Program - consists of 2 components, an academic detailing session and facilitated role-play with a simulated patient, delivered in one one-on-one session by an experienced communication facilitator (approx. 90 mins). - The academic detailing will review evidence and methodology for calculating prognosis and evidence and strategies for discussing life expectancy and end of life issues. A 'take home' pack will also be provided consisting of current literature and a DVD modelling ideal communication behaviours and responses to challenging questions from the Question Prompt List. - The facilitated role-play will simulate a consultation with a patient who has advanced incurable cancer. The oncologist will be encouraged to practice the skills discussed in the academic detailing whilst the simulated patient will ask questions and react realistically to the oncologist's responses and behaviours.
Sponsors
The University of Sydney
Study design
Allocation
Randomised controlled trial
Intervention model
Factorial
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Participants must be patients, carers or oncologists at participating hospitals. All must be over 18 years of age , have a good comprehension of the English language and be able to give informed consent. - Patients must be current patients of participating oncologists who have advanced, incurable cancer with a life expectancy of between 2 and 12 months. - Carers must be identified as the primary carers of a patient enrolled in the study. - Oncologists must be medical or radiation oncologists. NOTE: Patients will NOT be excluded from participating if they do not nominate a carer to the study
Exclusion criteria
Children and/or young people (i.e. <18 years) have been excluded as communication regarding end of life issues would be substantially different for this age group. People with intellectual or mental impairment have also been excluded as active participation in the intervention would be required, together with self-report measurement. The application of the intervention to these groups lies beyond the scope of the current study.
Outcome results
None listed