Randomized trial of a question prompt list to increase patient active participation during interactions with black patients and their oncologists

Abstract

Objective Communication during racially-discordant interactions is often of poor quality and may contribute to racial treatment disparities. We evaluated an intervention designed to increase patient active participation and other communication-related outcomes during interactions between Black patients and non-Black oncologists. Methods Participants were 18 non-Black medical oncologists and 114 Black patients at two cancer hospitals in Detroit, Michigan, USA. Before a clinic visit to discuss treatment, patients were randomly assigned to usual care or to one of two question prompt list (QPL) formats: booklet (QPL-Only), or booklet and communication coach (QPL-plus-Coach). Patient-oncologist interactions were video recorded. Patients reported perceptions of the intervention, oncologist communication, role in treatment decisions, and trust in the oncologist. Observers assessed interaction length, patient active participation, and oncologist communication. Results The intervention was viewed positively and did not increase interaction length. The QPL-only format increased patient active participation; the QPL-plus-Coach format decreased patient perceptions of oncologist communication. No other significant effects were found. Conclusion This QPL booklet is acceptable and increases patient active participation in racially-discordant oncology interactions. Future research should investigate whether adding physician-focused interventions might improve other outcomes. Practice Implications This QPL booklet is acceptable and can improve patient active participation in racially-discordant oncology interactions.

The impact of Black cancer patients' race-related beliefs and attitudes on racially-discordant oncology interactions: A field study

“…The study used de-identified data from a larger randomized control trial testing an intervention to improve communication between Black cancer patients and non-Black oncologists (Eggly et al, 2017). It was conducted between April 2012 and December 2014 in outpatient clinics of two cancer hospitals.…”

“…In general, communication and information exchange between physicians and patients in these interactions are poorer than in racially concordant interactions (Eggly et al, 2017). These dynamics of racially discordant medical interactions have significant practical implications for Black cancer patients: Over 80% of Black patients’ interactions with oncologists are racially discordant (Hamel et al, 2015).…”

Discussing prognosis and treatment goals with patients with advanced cancer: A qualitative analysis of oncologists’ language

“…Study Data were taken from a larger National Cancer Institute‐funded study conducted from 2012 to 2014, designed to improve patient‐oncologist communication during racially discordant interactions in the outpatient clinics of two cancer hospitals in Detroit, Michigan, USA . Oncologists were eligible to participate if they treated patients with breast, colon or lung cancer.…”

Culturally and linguistically diverse oncology patients' perspectives of consultation audio‐recordings and question prompt lists

“…Question prompt lists have been found to give English‐speaking patients an established means, and permission, to engage in their healthcare, and increase the number of questions they ask in oncology consultations . Question prompt lists have also been used to improve communication in interactions between health professionals and English‐speaking patients from different ethnic backgrounds . While QPLs have been shown to be of benefit in English‐speaking cohorts, patient preference regarding the method and timing of delivery has not yet been determined …”

“…15,26 Question prompt lists have also been used to improve communication in interactions between health professionals and English-speaking patients from different ethnic backgrounds. 27 While QPLs have been shown to be of benefit in English-speaking cohorts, patient preference regarding the method and timing of delivery has not yet been determined. 15 Our research team previously developed and piloted a communication intervention package comprising consultation ARs and QPLs to improve care for Arabic, Greek, Mandarin, and Cantonese-speaking patients with cancer.…”