Discussion About Goals of Care May Improve Patient Understanding
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 (http://abstracts.asco.org/199/AbstView_199_186200.html).
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.