RCT of Patient, Caregiver and Physician Communication Coaching in Advanced Cancer

晚期癌症患者、护理人员和医生沟通辅导的随机对照试验

• 批准号: 8837906
• 负责人: Ronald M. Epstein
• 金额: $ 54.94万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-06-01 至 2017-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8837906
• 关键词: Address; Advanced Malignant Neoplasm; Affect; Attention; Caregivers; Caring; Charge; Communication; Communication Research; Consultations; Critical Illness; Data; Diagnosis; Emotional; Enrollment; Equilibrium; Face; Feedback; Frustration; Goals; Healthcare; Individual; Interactive Communication; Intervention; Intervention Studies; Life; Oncologist; Outcome; Outcome Measure; Palliative Care; Participant; Patient Participation; Patients; Personal Satisfaction; Physicians; Play; Quality of life; Randomized; Reporting; Research; Risk; Role; Severity of illness; Site; Surveys; Testing; Visit; base; clinical decision-making; communication behavior; design; expectation; experience; group intervention; health care service utilization; hospice environment; improved; insight; instructor; meetings; novel; outcome forecast; outreach; patient oriented; peace; primary outcome; prognostic; psychologic; psychological distress; quality of death; skills; social; sound; theories; therapy design; treatment as usual

DESCRIPTION (provided by applicant): Crafting care that is concordant with the patient's wishes in the context of serious illness requires clear, frank and sensitive communication focused on the issues of greatest importance to the patient. We aim to test a potentially powerful intervention - targeting physicians, patients and caregivers - to improve discussions regarding prognosis and treatment choices in advanced cancer. These discussions are critical to involving patients in their care, whether or not they wish to assume responsibility for making major health care decisions. Patients who have had these discussions are less likely to be misinformed about the illness, less likely to get unwarranted aggressive care and more likely to experience improved well-being. Yet, these crucial discussions frequently do not occur. As predicted by ecological theory, individually-focused interventions - targeting clinicians or patients, or using third parties - are of limited benefit in improving communication. Our approach, informed by ecological theory, is designed to optimize communication - and patient well-being - by aligning patient, caregiver and physician communication towards common goals. In this resubmission, we respond to PA-09-122: Research on Clinical Decision Making in People with or at Risk for Life-Threatening Illness and have new Specific Aims: To determine whether a combined intervention for patients/caregivers and physicians a) improves communication regarding prognosis and treatment choices in advanced cancer (primary outcome), b) improves patient well-being and c) affects health services utilization. Design is a two-site cluster RCT of a 2- component intervention designed to improve communication about prognosis and treatment choices in advanced cancer and promote patient participation in discussions regarding their care. Oncologists (N=30) will be randomized to usual-care control or the intervention: two in-office sessions providing individual tailored feedback on their communication skills. Patients (n = 300) with advanced cancer and their caregivers will be assigned to usual-care control or the intervention: pre-visit coaching and question-prompt lists to address the same communication goals as physicians. We have piloted both components of the intervention. Main outcome measures derived from audio-recorded patient-caregiver-oncologist visits will assess a) interactive communication, including responding to patients' concerns; informing patients about treatment choices; balanced framing of prognoses; and engaging patients to participate in decisions. We will also assess b) communication 1 week following the visit and patient well-being (psychological distress, quality of life, sense of peace, and quality of death) at study entry and every 3 months using patient and caregiver surveys; and c) utilization of aggressive interventions in the last week of life and palliative care and hospice consultations following study enrollment using chart audit. Significance: The proposed study addresses critically important barriers to effective communication in the context of life-limiting illness. It is the first to test a novel communication intervention targeting physicians, patients and caregivers, and it is scalable for dissemination.

描述（由申请人提供）：在患有严重疾病的情况下，精心设计符合患者意愿的护理需要针对患者最重要的问题进行清晰、坦诚和敏感的沟通。我们的目标是测试一种针对医生、患者和护理人员的潜在强大干预措施，以改善有关晚期癌症预后和治疗选择的讨论。这些讨论对于让患者参与护理至关重要，无论他们是否愿意承担做出重大医疗保健决策的责任。进行过这些讨论的患者不太可能被错误地告知疾病，不太可能获得不必要的积极护理，并且更有可能体验到健康状况的改善。然而，这些关键的讨论常常不会发生。正如生态理论所预测的那样，针对临床医生或患者或使用第三方的针对个人的干预措施在改善沟通方面的益处有限。我们的方法以生态理论为基础，旨在通过协调患者、护理人员和医生的沟通以实现共同目标，从而优化沟通和患者福祉。在本次重新提交中，我们对 PA-09-122：患有或有生命危险疾病风险的人的临床决策研究做出回应，并制定了新的具体目标：确定对患者/护理人员和医生的联合干预是否 a) 改善有关晚期癌症预后和治疗选择的沟通（主要结果），b) 改善患者福祉，c) 影响卫生服务利用。设计是一项由两部分组成的干预措施的两中心随机对照试验，旨在改善晚期癌症预后和治疗选择的沟通，并促进患者参与有关其护理的讨论。肿瘤科医生（N = 30）将被随机分配到常规护理控制或干预组：两次办公室会议，提供针对其沟通技巧的个人定制反馈。患有晚期癌症的患者 (n = 300) 及其护理人员将被分配进行常规护理控制或干预：访视前辅导和问题提示列表，以实现与医生相同的沟通目标。我们已经对干预措施的两个部分进行了试点。来自患者-护理人员-肿瘤科医生录音拜访的主要结果指标将评估 a) 互动沟通，包括回应患者的担忧；告知患者治疗选择；平衡的预测框架；并让患者参与决策。我们还将使用患者和护理人员调查评估 b) 就诊后 1 周的沟通情况以及研究开始时患者的健康状况（心理困扰、生活质量、平静感和死亡质量）以及每 3 个月进行一次的调查； c) 在生命的最后一周利用积极的干预措施以及使用图表审核进行研究登记后的姑息治疗和临终关怀咨询。意义：拟议的研究解决了在限制生命的疾病背景下有效沟通的极其重要的障碍。它是第一个针对医生、患者和护理人员测试新型沟通干预措施的项目，并且可扩展以进行传播。

项目成果

Media, messages, and medication: strategies to reconcile what patients hear, what they want, and what they need from medications.

• DOI: 10.1186/1472-6947-13-s3-s5
• 发表时间: 2013
• 期刊: BMC medical informatics and decision making
• 影响因子: 3.5
• 作者: Kravitz RL;Bell RA
• 通讯作者: Bell RA

Reply to Hope, optimism, and the importance of caregivers in end-of-life care.

回复希望、乐观以及护理人员在临终关怀中的重要性。

• DOI: 10.1002/cncr.32441
• 发表时间: 2019
• 期刊: Cancer
• 影响因子: 6.2
• 作者: Trevino,KellyM;Prigerson,HollyG;Epstein,RonaldM;Duberstein,PaulR
• 通讯作者: Duberstein,PaulR

Promoting End-of-Life Discussions in Advanced Cancer: Effects of Patient Coaching and Question Prompt Lists.

促进晚期癌症的临终讨论：患者辅导和问题提示列表的效果。

• DOI: 10.1200/jco.2016.68.5651
• 发表时间: 2017
• 期刊: Journal of clinical oncology : official journal of the American Society of Clinical Oncology
• 作者: Rodenbach,RachelA;Brandes,Kim;Fiscella,Kevin;Kravitz,RichardL;Butow,PhyllisN;Walczak,Adam;Duberstein,PaulR;Sullivan,Peter;Hoh,Beth;Xing,Guibo;Plumb,Sandy;Epstein,RonaldM
• 通讯作者: Epstein,RonaldM

Conceptualizing and Counting Discretionary Utilization in the Final 100 Days of Life: A Scoping Review.

• DOI: 10.1016/j.jpainsymman.2019.10.009
• 发表时间: 2020-04
• 期刊: Journal of pain and symptom management
• 影响因子: 4.7
• 作者: Duberstein PR;Chen M;Hoerger M;Epstein RM;Perry LM;Yilmaz S;Saeed F;Mohile SG;Norton SA
• 通讯作者: Norton SA

Preference for Palliative Care in Cancer Patients: Are Men and Women Alike?

• DOI: 10.1016/j.jpainsymman.2018.03.014
• 发表时间: 2018-07-01
• 期刊: JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
• 影响因子: 4.7
• 作者: Saeed, Fahad;Hoerger, Michael;Duberstein, Paul R.
• 通讯作者: Duberstein, Paul R.