Parallel multicentre randomised trial of a clinical trial question prompt list in patients considering participation in phase 3 cancer treatment trials

Accepted 9 February 2017Objective: To evaluate the effect of a clinical trial question prompt list in patients considering enrolment in cancer treatment trials. Setting: Tertiary cancer referral hospitals in three state capital cities in Australia. Participants: 88 patients with cancer attending three cancer centres in Australia, who were considering enrolment in phase 3 treatment trials, were invited to enrol in an unblinded randomised trial of provision of a clinical trial question prompt list (QPL) before consenting to enrol in the treatment trial. Interventions: We developed and pilot tested a targeted QPL for patients with cancer considering clinical trial participation (the clinical trial QPL). Consenting patients were randomised to receive the clinical trial QPL or not before further discussion with their oncologist and/or trial nurse about the treatment trial. Primary and secondary outcomes: Questionnaires were completed at baseline and within 3â €..weeks of deciding on treatment trial participation. Main outcome measure: scores on the Quality of Informed Consent questionnaire (QuIC). Results: 88 patients of 130 sought for the study were enrolled (43 males), and 45 received the clinical trial QPL. 49% of trials were chemotherapy interventions for patients with advanced disease, 35% and 16% were surgical adjuvant and radiation adjuvant trials respectively. 70 patients completed all relevant questionnaires. 28 of 43 patients in the control arm compared with 39 of 45 patients receiving the clinical trial QPL completed the QuIC (p=0.0124). There were no significant differences in the QuIC scores between the randomised groups (QuIC part A p=0.08 and QuIC part B p=0.92). There were no differences in patient satisfaction with decisions or in anxiety levels between the randomised groups. Conclusions: Use of a question prompt list did not significantly change the QuIC scores in this randomised trial. ANZCTR 12606000214538 prospectively registered 31/5/2006. Trial registration number: Results, ACTRN12606000214538.Martin H N Tattersall, Michael Jefford, Andrew Martin, Ian Olver, John F Thompson, Richard F Brown, Phyllis N Buto

The characteristics and effectiveness of Question Prompt List interventions in oncology: a systematic review of the literature

Objective Question Prompt Lists (QPLs) have been used extensively in the oncology setting to improve communication, psychological and/or cognitive outcomes. In this systematic review, the objectives were to (a) examine the methodological quality of QPL interventions, (b) review the effectiveness of QPL interventions on communication, psychological and/or cognitive outcomes of cancer patients, (c) gain more insight into the characteristics of QPL interventions (e.g., the number and content of questions, and the mode of delivery) and (d) explore whether the effectiveness of QPL interventions might be explained by their characteristics. Method A systematic literature search was conducted in PsycINFO, Medline, CINAHL and CENTRAL. Empirical studies that investigated the use and effectiveness of QPL interventions in an oncology setting were included. The methodological quality of the included studies was assessed using the Cochrane method. Results Sixteen articles met the inclusion criteria. Results indicated evidence for the effectiveness of QPL interventions in enhancing patient participation (i.e., question asking). Furthermore, there was evidence that QPL interventions can influence psychological outcomes (i.e., anxiety at follow-up) and cognitive outcomes (i.e., recall of information). The majority of QPL interventions were given to patients before their consultation in hardcopy. In most studies, QPLs were combined with other intervention components. It is suggested that characteristics of a QPL intervention (i.e., the number of questions on a QPL and provider training) can influence its effectiveness. Conclusion Question Prompt List interventions are effective in improving communication, psychological and cognitive outcomes of cancer patients

Measuring cancer care coordination: Development and validation of a questionnaire for patients

10.1186/1471-2407-11-298BMC Cancer1129

'It breaks a narrative of paramedics, that we're lifesavers' : A qualitative study of health professionals', bereaved family members' and carers' perceptions and experiences of palliative paramedicine

Background: Paramedic practice is diversifying to accommodate evolving global health trends, including community paramedicine models and growing expertise in palliative and end-of-life care. However, despite palliative care specific clinical practice guidelines and existing training, paramedics still lack the skills, confidence and clinical support to provide this type of care. Aim: To elicit paramedics’, palliative care doctors and nurses’, general practitioners’, residential aged care nurses’ and bereaved families and carers’ experiences, perspectives, and attitudes on the role, barriers and enablers of paramedics delivering palliative and end-of-life care in community-based settings. Design: A qualitative study employing reflexive thematic analysis of data collected from semi-structured online interviews was utilised. Setting/participants: A purposive sample of 50 stakeholders from all Australian jurisdictions participated. Results: Five themes were identified: positioning the paramedic (a dichotomy between the life saver and community responder); creating an identity (the trusted clinician in a crisis), fear and threat (feeling afraid of caring for the dying), permission to care (seeking consent to take a palliative approach) and the harsh reality (navigating the role in a limiting and siloed environment). Conclusion: Paramedics were perceived to have a revered public identity, shaped by their ability to fix a crisis. However, paramedics and other health professionals also expressed fear and vulnerability when taking a palliative approach to care. Paramedics may require consent to move beyond a culture of curative care, yet all participant groups recognised their important adjunct role to support community-based palliative care

Fear of Cancer Recurrence in an Era of Personalized Medicine

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