Training oncologists and preparing patients for shared decision making about palliative systemic treatment: results from the randomized controlled...

Date 21 October 2018
Event ESMO 2018 Congress
Session Proffered paper session - Supportive and palliative care
Topics Career Development
Palliative Care
Patient Education and Advocacy
Presenter Hanneke van Laarhoven
Citation Annals of Oncology (2018) 29 (suppl_8): viii548-viii556. 10.1093/annonc/mdy295
Authors H.W.M. van Laarhoven1, I. Henselmans2, P. van Maarschalkerweerd3, H. de Haes3, D.W. Sommeijer4, P.B. Ottevanger5, H. Fiebrich6, S.E. Dohmen7, G.M. Creemers8, F.Y.F.L. De Vos9, E.M. Smets10
  • 1Medical Oncology, Academic Medical Center, University of Amsterdam, 1100 DD - Amsterdam/NL
  • 2Medical Psychology, Academic Medical Center, 1105AZ - Amsterdam/NL
  • 3Medical Psychology, Academic Medical Center, Amsterdam/NL
  • 4Medical Oncology, Flevoziekenhuis, Almere/NL
  • 5Medical Oncology, Radboud University Medical Centre Nijmegen, 6500 HB - Nijmegen/NL
  • 6Medical Oncology, Isalaklinieken, Zwolle/NL
  • 7Medical Oncology, Bovenij Hospital, 1034 CS - Amsterdam/NL
  • 8Medical Oncology, Catharina Hospital Eindhoven, 5602 ZA - Eindhoven/NL
  • 9Medical Oncology, University Hospital Utrecht, 3508 GA - Utrecht/NL
  • 10Medical Psychology, Academic Medical Center (AMC), 1105AZ - Amsterdam/NL

Abstract

Background

Systematic treatment for advanced cancer offers uncertain and often limited benefits whilst the burden can be high. Hence, treatment decisions require Shared Decision Making (SDM). We examined the separate and combined effect of oncologist training and a patient communication aid on SDM in consultations about palliative systemic treatment.

Methods

A multi-center RCT with four parallel arms was conducted (NTR 5489). To attain a power of 80%, we included 31 medical oncologists and 194 of their patients with advanced cancer with a median life expectancy of < 12 months. Oncologists were randomized to receive training or not; patients were randomized to receive a patient communication aid or not. The oncologist training consisted of a reader, two group sessions, a booster feedback session and a consultation room tool. The patient communication aid consisted of a question prompt list and a value clarification exercise. Either an initial consultation about the start of systemic treatment or an evaluative consultation about (dis)continuation was audio-recorded for each patient. The primary outcome was observed SDM (OPTION12), rated by blinded assessors. Intervention effects were investigated with multilevel analysis.

Results

Audio-recorded consultations of 187 patients and 27 oncologists were available for analysis. The oncologist training had a large effect on observed SDM among patients who did not receive a communication aid (d = 1.4). The patient communication aid did not have an effect on SDM among untrained oncologists (d = 0.03). The effect of the combination of training and communication aid did not exceed the single effect of training (Mtraining_aid=49.83; Mtraining_no aid=49.49; Mno training_aid=29.88; Mno training_no aid=29.50).

Conclusions

Training medical oncologists in SDM about palliative systemic treatment improved observed SDM in clinical encounters. A patient communication aid preparing patients for SDM did not add to that effect. Additional analysis should examine the effects of both interventions on secondary outcomes, such as patient satisfaction and treatment decisions.

Clinical trial identification

Netherlands Trial Registry 5489 (prospective, Sep 15 2015).

Legal entity responsible for the study

Department of Medical Psychology, Academic Medical Center, Amsterdam.

Funding

Dutch Cancer Society.

Editorial Acknowledgement

Disclosure

H.W.M. van Laarhoven: Consultant or advisory role: BMS, Lilly and Nordic Pharma; Research funding: Bayer, BMS, Celgene, Janssen, Lilly, Nordic Pharma, Philips, Roche. F.Y.F.L. De Vos: Research funding: Novartis, AbbVie en BioClin. All other authors have declared no conflicts of interest.