The Heidelberg Milestones Communication Approach (MCA) for patients with prognosis &lt;12 months: protocol for a mixed-methods study including a randomized controlled trial

Siegle, Anja; Villalobos, Matthias; Bossert, Jasmin; Krug, Katja; Hagelskamp, Laura; Krisam, Johannes; Handtke, Violet; Deis, Nicole; Jünger, Jana; Wensing, Michel; Thomas, Michael

doi:10.1186/s13063-018-2814-1

Cited by 21 publications

(26 citation statements)

References 56 publications

(58 reference statements)

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“…To meet the challenge of coping with the complex needs of patients [7], an effective communication from the time of diagnosis between all involved persons (patients, family caregivers and healthcare providers) is essential [8]. The opportunity to communicate about the situation positively affects patients' quality of life [9].…”

Section: Introductionmentioning

confidence: 99%

“…In spite of knowing about the positive effects of communication, patients, caregivers and healthcare providers often perceive communication skills of healthcare staff to be suboptimal and fragmented. Therefore, training of communication skills is recommended [7,11] as well as a team approach to communication with patients, involving physicians and nurses. However, the actual application of communication skills in a team approach in routine practice remains difficult.…”

Section: Introductionmentioning

confidence: 99%

“…For patients newly diagnosed with lung cancer stage IV, a structured longitudinal communication concept was developed and implemented to proactively address their complex care needs: The Heidelberg Milestones Communication Approach (MCA) [7]. MCA aims at providing coherent care that integrates palliative care early and across the disease trajectory [7]. The concept includes four types of so-called milestone conversations (MCs) which involve patients, caregivers and an interprofessional tandem of physician and nurse navigator.…”

Section: Introductionmentioning

confidence: 99%

“…MCs are scheduled at specific pivotal times with a thematic focus in the disease trajectory: Disclosure of diagnosis and prognosis (MC 1), Treatment with response or stability of disease (MC 2), Disease progression with reassessment of options and change or stop of diseasemodifying interventions (MC 3), and Transition to best supportive care and end-of-life consensus (MC 4). In follow-up sessions about a week after each MC, the nurse calls patients to sustain communication [7]. Content and implementation of the MCA are described in detail in the manual (available (in German) upon request from the authors).…”

Section: Introductionmentioning

confidence: 99%

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Implementation of the milestones communication approach for patients with limited prognosis: evaluation of intervention fidelity

et al. 2020

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Background: Despite improvements in diagnostics and therapy, the majority of lung tumours are diagnosed at advanced stage IV with a poor prognosis. Due to the nature of an incurable disease, patients need to engage in shared decision making on advance care planning. To implement this in clinical practice, effective communication between patients, caregivers and healthcare professionals is essential. The Heidelberg Milestones Communication Approach (MCA) is delivered by a specifically trained interprofessional tandem and consists of four milestone conversations (MCs) at pivotal times in the disease trajectory. MC 1 (Diagnosis): i.e. prognosis; MC 2 (Stable disease): i.e. prognostic awareness; MC 3 (Progression): i.e. reassessment; MC 4 (Best supportive care): i.e. end of treatment. In between MCs, follow-up calls are carried out to sustain communication. This study aimed to assess to what extent the MCA was implemented as planned and consolidated in specialized oncology practice. Methods: A prospective observational process evaluation study was conducted, which focused on the implementation fidelity of the MCA. All MCs during two assessment periods were included. We analysed all written records of the conversations, which are part of the routine documentation during MCs and follow-up calls. Adherence to key aspects of the manual was documented on structured checklists at the beginning of the implementation of the MCA and after 6 months. The analysis was descriptive. Differences between the two assessment periods are analysed with chi-square tests. Results: A total of 133 MCs and 54 follow-up-calls (t1) and of 172 MCs and 92 follow-up calls (t2) were analysed. MC 2 were the most frequently completed conversations (n = 51 and n = 47). Advance care planning was discussed in 26 and 13% of MC 2 in the respective assessment periods; in 31 and 47% of MC 2, prognostic awareness was recorded. The most frequently documented topic in the follow-up calls was the physical condition in patients (82 and 83%). Conclusion: The implementation of a trajectory-specific communication concept was largely successful. Additional studies are needed to understand how fidelity could be further improved. Trial registration: DRKS00013469 / Date of registration: 22.12.2017.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Implementation of the milestones communication approach for patients with limited prognosis: evaluation of intervention fidelity

et al. 2020

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“…This concept introduces standardized steps of communication at turning points of treatment. Utilizing every patient-physician encounter as a communication opportunity and adding to the knowledge about the illness trajectory, we developed this concept further [37]. As interprofessional interventions show improved outcomes, we propose a team approach (physician and nurse navigator).…”

Section: Milestones In Advanced Lung Cancermentioning

confidence: 99%

Communication along Milestones in Lung Cancer Patients with Advanced Disease

et al. 2019

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Patients with advanced lung cancer and their caregivers are confronted with a complex situation as their disease-related burden comprises physical, psychosocial, and spiritual needs. During the illness trajectory with limited prognosis, they are exposed to different multidisciplinary healthcare settings and providers that challenge the continuity and coordination of care. Additionally, decision-making between active cancer treatment and end-of-life care constitutes a continuous balancing act. Several studies have shown that early integration of palliative care and adequate advance care planning improve quality of life and satisfaction with care. For this strategy, the communication skills of healthcare providers and interprofessional collaboration should be strengthened. A longitudinally structured communication approach along pivotal milestones of the disease can empower patients by facilitating coping and prognostic awareness, and achieve early integration of palliative care and advance care planning. Good interprofessional collaboration and communication lead to better coordination and continuity of care.

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Shared Decision-making in Dermatology

et al. 2021

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hared decision-making (SDM) is a formal process of consensus building between health care professionals and patients to select treatment plans based on the best medical evidence and the patient's values. Shared decision-making has been reported to improve patient knowledge, satisfaction, and adherence to treatment. 1 Active collaboration between patient and the clinician is important based on the premises that patients will better adhere to treatment if they understand and agree to its use. Shared decision-making is a measure of high-quality decisionmaking and has been incorporated into reimbursement by payers and legislation of health care models. [2][3][4] Shared decision-making has been broadly applied to medical and surgical specialties since it was first defined in 1982. 5 Shared decisionmaking is particularly relevant in complex, preference-sensitive de-cision-making when there are several medically reasonable alternatives. 6 Fields such as palliative care, oncology, and cardiology have been leaders in the implementation of SDM. [7][8][9][10][11] In addition, the Centers for Medicare & Medicaid Services Innovation Center has developed payment models to encourage clinicians to use patient decision support tools aimed to improve individual understanding of medical options as well as requiring SDM for payment of procedures. 2 Dermatologists and patients co-manage complex chronic conditions with medical, economic, and quality-of-life implications. Decision tools, also known as patient decision aids (PDAs), provide detailed and balanced, evidence-based information about varying treatment options and can therefore be used before, during, or after a clinic visit. 12,13 These tools can be used by the patient before IMPORTANCE Shared decision-making (SDM) can improve the quality of care for patients. The extent to which this tool has been used and the evidence supporting its use in dermatology have not been systematically examined.OBJECTIVE To perform a scoping review of the literature regarding SDM in dermatology.

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The Heidelberg Milestones Communication Approach (MCA) for patients with prognosis <12 months: protocol for a mixed-methods study including a randomized controlled trial

Cited by 21 publications

References 56 publications

Implementation of the milestones communication approach for patients with limited prognosis: evaluation of intervention fidelity

Implementation of the milestones communication approach for patients with limited prognosis: evaluation of intervention fidelity

Communication along Milestones in Lung Cancer Patients with Advanced Disease

Shared Decision-making in Dermatology

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