Discussing goals of care with patients with advanced cancer can provide better information on the disease, treatment options, and prognosis, as well as elicit patient values. A randomized, controlled trial tested a coaching model to improve healthcare providers’ communication on goals of care. The study’s findings were presented at the 2017 ASCO Annual Meeting.
The researchers recruited oncologists (n = 22) who were managing patients (n = 96) with advanced cancer with a prognosis of less than two years. The researchers defined a goals of care discussion as a patient-reported occurrence of their doctor discussing the cancer prognosis and clarifying areas that were more important to them.
The mean physician age was 44 years (range = 32–66), and they were in practice for a mean of 14.5 years (range = 5–40). The mean patient age was 62 years (range = 20–95), 40% were female, and 58% were Caucasian.
Two-thirds of patients reported that their treatment goal was to cure their cancer, whereas just 14% reported that a cure was unlikely. Patients felt more knowledgeable (79%) when their doctors discussed treatments, adverse events, and quality of life compared to those whose doctors did not (21%; p = 0.02).
Compared to patients whose doctors did not have goals of care discussions, those whose doctors did felt more knowledgeable (63% versus 78%; p = 0.17) but did not feel clearer about their values (60% versus 54%; p = 0.59).
Factors that significantly affected knowledge included (p < 0.01 for all):
- Health literacy (odds ratio [OR] = 0.2; 95% confidence interval [CI] = 0.07–0.82)
- Having a goals of care discussion (OR = 10.2; 95% CI = 1.7–63.1)
- Receiving a goals of care discussion with the doctor (OR = 8.8; 95% CI = 1.4–55.2).
However, discussing what is important to patients did not help patients feel clearer about their values (OR = 2.7; 95% CI = 0.6–12.2; p < 0.05).
“Using a coaching model to teach oncologists communication skills may improve patients’ understanding of what to expect with their cancer, but [it] does not impact their clarity of values,” the authors concluded.