Importance of timely conversations about serious illness
Earlier and better conversations between clinicians and patients with advanced cancer lead to better outcomes, a study shows
Earlier and better conversations between clinicians and seriously ill patients lead to better outcomes, a study shows
Improving, increasing, integrating and better documenting conversations about serious illness with regard to the patient’s preferences, values and goals is possible and desirable, according to an American study, which evaluated the effectiveness of a communication quality improvement intervention.
In this four-year randomised controlled trial, researchers from the Dana-Farber Cancer Institute in Boston, US, examined the utility of a structured communication programme in cancer care. This programme used a documentary tool called the serious illness conversation guide and skills-based training and coaching, augmented by reminder emails and documentation specific to raising and recording such issues in the clinician-patient meeting.
The study enrolled 91 clinicians, comprising physicians, nurse practitioners and physicians’ assistants (48 intervention, 43 control), and 278 patients with advanced cancer (134 intervention, 144 control). A patient’s inclusion in the study was decided by a positive response to the question: ‘Would you be surprised if this patient died in the next year?’
The authors say: ‘Earlier clinician-patient conversations about patients’ values, goals, and preferences in serious illness are associated with better outcomes, but occur inconsistently in cancer care.’
The paper reports secondary outcomes, with results suggesting that more participants in the study group had a documented discussion, which was also more detailed and patient-centred. The discussions focused on their goals and values, their comprehension of their illness or prognosis, and preferences for life-sustaining intervention. These conversations were held a median of 2.4 months earlier in the study group compared with the control sample.
- Paladino J, Bernacki R, Neville B (2019) Evaluating an intervention to improve communication between oncology clinicians and patients with life-limiting cancer: a cluster randomised clinical trial of the serious care program
Compiled by Dion Smyth, lecturer in cancer and palliative care at Birmingham City School of Nursing and Midwifery