Promoting patient participation in the cancer consultation: evaluation of a prompt sheet and coaching in question-asking

Abstract

Summary Active participation in the medical consultation has been demonstrated to benefit aspects of patients' subsequent psychological well-being. We investigated two interventions promoting patient question-asking behaviour. The first was a question prompt sheet provided before the consultation, which was endorsed and worked through by the clinician. The second was a face to face coaching session exploring the benefits of, and barriers to, question-asking, followed by coaching in question-asking behaviour employing rehearsal techniques. Sixty patients with heterogeneous cancers, seeing two medical oncologists for the first time, were randomly assigned to one of three groups: two intervention groups and one control group. Sociodemographic variables and anxiety were assessed prior to the intervention which preceded the consultation. The consultations were audiotaped and subsequently analysed for question-asking behaviour. Anxiety was assessed again immediately following the consultation. Questionnaires to assess patient satisfaction, anxiety and psychological adjustment were sent by mail 2 weeks following the consultation. Presentation and discussion of the prompt sheet significantly increased the total number of questions asked and the number of questions asked regarding tests and treatment. Coaching did not add significantly to the effects of the prompt sheet. Psychological outcomes were not different among the groups. We conclude that a question prompt sheet addressed by the doctor is a simple, inexpensive and effective means of promoting patient question asking in the cancer consultation.

Evaluation of question-listing at the Cancer Support Community

“…Roter initiated this line of research into question-asking and found in a randomized controlled trial that patients coached to make a personalized list of questions before a primary care consultation asked more direct questions during the visit [2]. Others found similar results, even when prompt sheets were used without coaching [4][5][6][7]. Overall, a meta-analysis of question-listing interventions featuring 8,244 patients in 33 randomized controlled trials found an increase in questionasking [8].…”

“…After extensive work in academic settings [5][6][7]9, 10], Dimoska et al published an account of a limited-term implementation in a community clinic in Australia [11]. Belkora and colleagues have reported on long-term implementations in academic and community settings with a regional reach around Northern California [12][13][14][15][16][17].…”

Communication in cancer genetic counselling: does it reflect counselees' previsit needs and preferences?

“…Newly referred counselees may be helped by receiving more information on the counselling procedure prior to the consultation, and they may be advised on how to prepare their visit. They may, for example, be encouraged to write down questions in advance, possibly helped by a prompt sheet such as was successfully devised for promoting cancer patients' participation (Brown et al, 1999;Wells et al, 2004), or to send questions ahead to the counsellor.…”

Disarming the guarded prognosis: predicting survival in newly referred patients with incurable cancer

“…We developed and tested a question prompt list designed to improve communication when cancer patients see a medical or radiation oncologist for the first time. In three separate randomised trials of this intervention, prognosis was the only topic about which patients who received the question prompt list asked more questions, even though only two of the 17 suggested questions were about prognosis (Butow et al, 1994;Brown et al, 1999Brown et al, , 2001. This failure to discuss prognosis is probably caused as much by doctors' uncertainty about how to think and talk about prognosis as it is by patients' reluctance to ask about it (Brown et al, 1999(Brown et al, , 2001).…”

“…In three separate randomised trials of this intervention, prognosis was the only topic about which patients who received the question prompt list asked more questions, even though only two of the 17 suggested questions were about prognosis (Butow et al, 1994;Brown et al, 1999Brown et al, , 2001. This failure to discuss prognosis is probably caused as much by doctors' uncertainty about how to think and talk about prognosis as it is by patients' reluctance to ask about it (Brown et al, 1999(Brown et al, , 2001). Christakis and Lamont (2000) reported that doctors were inaccurate in their estimates of prognosis for terminally ill patients, and that their errors were systematically optimistic.…”