Can consultation skills training change doctors' behaviour to increase involvement of patients in making decisions about standard treatment and clinical trials: a randomized controlled trial

Butow, Phyllis; Brown, Richard F.; Aldridge, Julie; Juraskova, Ilona; Zoller, Peter; Boyle, F; Wilson, Mary S.; Bernhard, Jürg

doi:10.1111/hex.12229

Cited by 34 publications

(51 citation statements)

References 33 publications

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“…Training in consultation skills may help facilitate exploration of patients' experience as well as install a collaborative communication (Butow et al, 2015) to discuss the hierarchy of competing objectives, such as life prolongation versus comfort, in a supportive environment. This may cloud healthcare professional judgement (and possibly lead to underestimate patients' side effects).…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, they seemed to refer to doctors for the decision of treatment discontinuation. Training in consultation skills may help facilitate exploration of patients' experience as well as install a collaborative communication (Butow et al, 2015) to discuss the hierarchy of competing objectives, such as life prolongation versus comfort, in a supportive environment.…”

Section: Discussionmentioning

confidence: 99%

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Patients’ perceived tolerance of side effects in phase I cancer clinical trials: A qualitative study

Brédart

Bodson²,

Tourneau

et al. 2016

Eur J Cancer Care

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This qualitative study aimed to explore cancer patients' perceived tolerance of side effects in phase I drug trials. Patients with solid tumours receiving molecularly targeted agents with/without chemotherapy were eligible for inclusion. In-depth semi-structured interviews were carried out with 17 patients with a median [range] age of 63 [41-72] years. Treatment was discontinued in seven patients. Verbatim transcripts of the audio-taped interviews were analysed using a constructivist grounded theory approach. Four conceptual categories emerged from data analysis, labelled "suffering from side effects" comprising a range of symptoms, psychosocial or role disturbances; "striving to cope with side effects" reflecting psychological strategies for managing side effects; "hoping" reflecting expectations about treatment efficacy and relief from side effects; and "appraisal of care." Among patients remaining in the trial, treatment was currently perceived as fairly tolerable. For most respondents, whether still in a trial or not, treatment discontinuation could not be justified by the non-tolerance of treatment side effects. These results question the adequacy of patient-perceived tolerance reports to determine an optimal drug dose for phase II trials. Confronted with patients' hopes and inappropriate beliefs, communication is challenging in phase I trials and could benefit from facilitating psychosocial interventions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Patients’ perceived tolerance of side effects in phase I cancer clinical trials: A qualitative study

Brédart

Bodson²,

Tourneau

et al. 2016

Eur J Cancer Care

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“…Generally, authors did not recommend different communication strategies for different phases of clinical trials. Seven trainings out of the 22 analyzed in this review instructed participants on how to check for patients' understanding of the information provided [10,13,29,30,34,37,42]. In this regard, Mann et al [10] and Brown et al [37] reported "summarizing" as a useful technique to check for patients' understanding.…”

Section: Information Conveyedmentioning

confidence: 99%

“…Similarly, the pedagogical tools adopted were varied. There was a general preference for the use of video materials, such as DVDs or videotaped scenarios, which were used in 10 training programs [29,30,[33][34][35][36][37][38][39][40]. Other formats used included case studies, vignettes, instructional manuals, dummy referral letters, protocols, and didactic presentations.…”

Section: Content Development and Pedagogic Toolsmentioning

confidence: 99%

“…In this regard, Mann et al [10] and Brown et al [37] reported "summarizing" as a useful technique to check for patients' understanding. Other topics specifically addressed by the training programs included how to explain the aims of clinical trials [10,13,29,30,39,41], the importance of informing patients about the voluntariness of their potential enrollment [10,11,29,30,33], or the importance of avoiding coercive behaviors and/or the importance of adopting a shared decision making process [34,35,37]. In some training, participants were instructed on strategies for clarifying key terms such as "randomization" and "placebo," which tend to be difficult for a large proportion of patients to understand or accept [10,13,30,36,39,41,42,45,46,48].…”

Section: Information Conveyedmentioning

confidence: 99%

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Training Programs for Improving Communication about Medical Research and Clinical Trials: A Systematic Review

Occa¹,

Morgan²

2018

Clinical Trials in Vulnerable Populations

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Objectives: The aim of this article is to provide recommendations on the structure, materials, and outcomes that should be adopted for communication training programs designed to improve clinical trial education for patients. Methods:A systematic review of peer-reviewed articles was conducted. A total of 22 studies were included. Several dimensions were analyzed, such as program design, content development, pedagogical tools, content of the program, and the outcomes affected. Results:The trainings described in the articles analyzed generally took the form of workshops and were developed by groups of heterogeneous experts. Trainings used a variety of educational materials and activities often developed by the research team hosting the training. The outcome measures and assessment methods were not consistent among the trainings, which hinders the ability to statistically synthetize findings. Conclusions:Findings from the review point to a number of recommendations for the development of future clinical research communication training programs. Training programs should be developed by a team of experts with a range of expertise and should be organized in the form of workshops. Participants should be able to role-play newly acquired communication skills using standardized patients.

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Controlled Interventions to Reduce Burnout in Physicians

et al. 2017

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IMPORTANCE: Burnout is prevalent in physicians and can have a negative influence on performance, career continuation and patient care. Existing evidence does not allow clear recommendations for the management of burnout in physicians. OBJECTIVE: To evaluate the effectiveness of interventions to reduce burnout in physicians. We also examined whether different types of interventions (physician-directed or organization-directed interventions), physician characteristics (length of experience) and healthcare setting characteristics (primary or secondary care) were associated with improved effects. DATA SOURCES: Medline, Embase, PsycINFO, Cinahl, and Central, were searched from inception to May 2016. The reference lists of eligible studies and other relevant systematic reviews were hand-searched. STUDY SELECTION: Randomized controlled trials and controlled before-after studies of interventions targeting burnout in physicians. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data and assessed the risk of bias. The main meta-analysis was followed by a number of pre-specified subgroup and sensitivity analyses. All analyses were performed using random-effects models and heterogeneity was quantified using I 2. MAIN OUTCOME AND MEASURES: The core outcome was burnout scores focused on emotional exhaustion, reported as standardized mean differences and their 95% confidence intervals. RESULTS: Twenty independent comparisons from 19 studies were included in the metaanalysis (n=1,550 physicians). Interventions were associated with small significant reductions in burnout (SMD=-0.29, 95% CI=-0.42 to-0.16; equal to a drop of 3-points on the emotional exhaustion domain of the Maslach Burnout Inventory above change in the controls). Subgroup analyses suggested significantly improved effects for organization-5 directed interventions (SMD=-0.45, 95% CI=-0.62 to-0.28) compared to physician-directed interventions (SMD=-0.18, 95% CI=-0.32 to-0.03). Interventions delivered in experienced physicians and in primary care were associated with higher effects compared to interventions delivered in inexperienced physicians and in secondary care, but these differences were not significant. The results were not influenced by the risk of bias ratings. CONCLUSION: Evidence from this meta-analysis suggests that current intervention programs for burnout in physicians are associated with small benefits which may be boosted by adoption of organization-directed approaches. This finding provides support for the view that burnout is a problem of the whole healthcare organization, rather than individuals.

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Can consultation skills training change doctors' behaviour to increase involvement of patients in making decisions about standard treatment and clinical trials: a randomized controlled trial

Cited by 34 publications

References 33 publications

Patients’ perceived tolerance of side effects in phase I cancer clinical trials: A qualitative study

Patients’ perceived tolerance of side effects in phase I cancer clinical trials: A qualitative study

Training Programs for Improving Communication about Medical Research and Clinical Trials: A Systematic Review

Controlled Interventions to Reduce Burnout in Physicians

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