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.
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.
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DOI：
10.1001/jamaoncol.2016.4373
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发表时间：
2017-01-01
期刊：
影响因子：
28.4
通讯作者：
Kravitz RL
中科院分区：
文献类型：
--
作者：
Epstein RM;Duberstein PR;Fenton JJ;Fiscella K;Hoerger M;Tancredi DJ;Xing G;Gramling R;Mohile S;Franks P;Kaesberg P;Plumb S;Cipri CS;Street RL Jr;Shields CG;Back AL;Butow P;Walczak A;Tattersall M;Venuti A;Sullivan P;Robinson M;Hoh B;Lewis L;Kravitz RL
观察性研究表明，以患者为中心的沟通、生活质量（QOL）以及晚期癌症的积极治疗之间存在关联，但关于沟通干预的随机临床试验（RCT）报道较少。
为了确定一项涉及肿瘤医生、晚期癌症患者及其照顾者的综合干预措施是否会促进以患者为中心的沟通，并评估该干预措施对共同理解、医患关系、生活质量以及生命最后30天的积极治疗的影响。
在纽约西部和北加利福尼亚的社区及医院癌症诊所进行的整群随机临床试验；38名肿瘤内科医生（平均年龄44.6岁；11名（29%）为女性）和265名居住在社区的成年晚期非血液系统癌症患者参与（平均年龄64.4岁，146名（55.0%）为女性，235名（89%）为白人；于2012年8月至2014年6月入组；随访3年）；194名患者有参与的照顾者。
肿瘤医生接受使用标准化患者指导者进行的个性化沟通培训，同时患者接受问题提示清单和个性化沟通指导，以确定在即将到来的肿瘤医生就诊期间要解决的问题。两种干预措施都侧重于让患者参与会诊、回应情绪、告知患者预后和治疗选择以及平衡信息框架。对照组参与者未接受培训。
预先设定的主要结局是从患者接受指导（干预组）或入组（对照组）后首次肿瘤医生就诊的录音中编码得出的以患者为中心的沟通的综合测量指标。次要结局包括医患关系、对预后的共同理解、生活质量以及生命最后30天的积极治疗和临终关怀的使用。
对来自38名肿瘤医生（19名随机分配到干预组）和265名患者（130名干预组）的数据进行了分析。在完全调整的模型中，干预措施在主要的医患沟通终点上产生了具有临床和统计学意义的改善（调整后的干预效应为0.34；95%置信区间为0.06 - 0.62；P = 0.02）。次要结局的差异无统计学意义。
一项包括肿瘤医生沟通培训和对晚期癌症患者进行指导的综合干预措施在改善以患者为中心的沟通方面是有效的，但未影响次要结局。
clinicaltrials.gov标识符：NCT01485627
Observational studies demonstrate links between patient-centered communication, quality of life (QOL), and aggressive treatments in advanced cancer, yet few randomized clinical trials (RCTs) of communication interventions have been reported. To determine whether a combined intervention involving oncologists, patients with advanced cancer, and caregivers would promote patient-centered communication, and to estimate intervention effects on shared understanding, patient-physician relationships, QOL, and aggressive treatments in the last 30 days of life. Cluster RCT at community- and hospital-based cancer clinics in Western New York and Northern California; 38 medical oncologists (mean age 44.6 years; 11 (29%) female) and 265 community-dwelling adult patients with advanced nonhematologic cancer participated (mean age, 64.4 years, 146 [55.0%] female, 235 [89%] white; enrolled August 2012 to June 2014; followed for 3 years); 194 patients had participating caregivers. Oncologists received individualized communication training using standardized patient instructors while patients received question prompt lists and individualized communication coaching to identify issues to address during an upcoming oncologist visit. Both interventions focused on engaging patients in consultations, responding to emotions, informing patients about prognosis and treatment choices, and balanced framing of information. Control participants received no training. The prespecified primary outcome was a composite measure of patient-centered communication coded from audio recordings of the first oncologist visit following patient coaching (intervention group) or enrollment (control). Secondary outcomes included the patient-physician relationship, shared understanding of prognosis, QOL, and aggressive treatments and hospice use in the last 30 days of life. Data from 38 oncologists (19 randomized to intervention) and 265 patients (130 intervention) were analyzed. In fully adjusted models, the intervention resulted in clinically and statistically significant improvements in the primary physician-patient communication end point (adjusted intervention effect, 0.34; 95% CI, 0.06–0.62; P = .02). Differences in secondary outcomes were not statistically significant. A combined intervention that included oncologist communication training and coaching for patients with advanced cancer was effective in improving patient-centered communication but did not affect secondary outcomes. clinicaltrials.gov Identifier: NCT01485627
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影响因子：
120.7
作者：
Curtis, J. Randall;Back, Anthony L.;Engelberg, Ruth A.
通讯作者：
Engelberg, Ruth A.
影响因子：
45.3
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Ahles, Tim A.
麦吉尔生活质量问卷--适合晚期疾病患者的生活质量测量方法--有效性和可接受性初步研究
影响因子：
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COHEN, SR;MOUNT, BM;BUI, F
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254.7
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Back, AL;Arnold, RM;Fryer-Edwards, K
通讯作者：
Fryer-Edwards, K
影响因子：
3.1
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Clayton, JM;Butow, PN;Tattersall, MHN
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Tattersall, MHN