Supportive Care in Cancer

, Volume 20, Issue 7, pp 1457–1464

Physician endorsement alone may not enhance question-asking by advanced cancer patients during consultations about palliative care

  • Josephine M. Clayton
  • Christine Natalia
  • Phyllis N. Butow
  • Judy M. Simpson
  • Angela M. O’Brien
  • Rhonda Devine
  • Martin H. N. Tattersall
Original Article

Abstract

Purpose

This study aimed to explore the effect of physician endorsement of question-asking on advanced cancer patients’ question-asking behaviour during consultations about palliative care and to explore other potential predictors of patient question-asking.

Methods

Data were obtained from 80 control group patients from a randomised controlled trial of standard palliative care (PC) consultation (control group) versus provision of a question prompt list (QPL) before the consultation. Consecutive eligible patients with advanced cancer referred to 15 PC physicians from nine Australian PC centres participated. Baseline measures were obtained from patients; consultations were audiotaped, transcribed and analysed by blinded coders; and physicians estimated the patients’ survival.

Results

Endorsement of question-asking by the physician was not related to the number of patient questions. Patients with the highest anxiety levels asked 3.5 times as many questions as those with least anxiety (incidence rate ratio (IRR) = 3.54, 95% confidence interval (CI) 1.90–6.59, P = 0.001). After allowing for the effect of anxiety, patients with an estimated survival of >12 weeks asked 76% more questions (IRR = 1.76, 95% CI 1.03–3.00, P = 0.04), whereas age, sex, educational background, occupation, information and involvement preferences and presence of a caregiver were not related to patient question-asking behaviour.

Conclusion

Physician endorsement of question-asking alone does not appear to increase questions by advanced cancer patients during consultations about PC. Additional resources such as QPLs may be needed to facilitate patient question-asking.

Keywords

Communication Palliative care Patient participation Physician–patient relations Question prompt lists Truth disclosure 

References

  1. 1.
    Epstein RM, Street RL (2007) Patient-centred communication in cancer care: promoting healing and reducing suffering. NIH Publication No. 07–6225. Bethesda: National Cancer InstituteGoogle Scholar
  2. 2.
    Degner LF, Kristjanson LJ, Bowman D et al (1997) Information needs and decisional preferences in women with breast cancer. JAMA 277:1485–1492PubMedCrossRefGoogle Scholar
  3. 3.
    Parker SM, Clayton JM et al (2007) A systematic review of prognostic/end-of-life communication with adults in the advanced stages of a life-limiting illness: patient/caregiver preferences for the content, style and timing of information. J Pain Symptom Manage 34:81–93PubMedCrossRefGoogle Scholar
  4. 4.
    Charles C, Gafni A, Whelan T (2000) How to improve communication between doctors and their patients: learning more about decision making context is important. BMJ 320:1220–1221PubMedCrossRefGoogle Scholar
  5. 5.
    Sandberg EH, Paul D, Sandberg WS (2009) A controlled study of the effects of patient information-elicitation style on clinical information giving. Commun Med 6:73–82PubMedCrossRefGoogle Scholar
  6. 6.
    Butow PN, Dunn SM, Tattersall MH et al (1994) Patient participation in the cancer consultation: evaluation of a question prompt sheet. Ann Oncol 5:199–204PubMedGoogle Scholar
  7. 7.
    Brown R, Butow PN, Boyer MJ et al (1999) Promoting patient participation in the cancer consultation: evaluation of a prompt sheet and coaching in question-asking. Br J Cancer 80:242–248PubMedCrossRefGoogle Scholar
  8. 8.
    Brown RF, Butow PN, Dunn SM et al (2001) Promoting patient participation and shortening cancer consultations: a randomised trial. Br J Cancer 85:1273–1279PubMedCrossRefGoogle Scholar
  9. 9.
    Butow P, Devine R, Boyer M et al (2004) Cancer consultation preparation package: changing patients but not physicians is not enough. J Clin Oncol 22:4401–4409PubMedCrossRefGoogle Scholar
  10. 10.
    Clayton J, Butow P, Tattersall M et al (2003) Asking questions can help: development and preliminary evaluation of a question prompt list for palliative care patients. Br J Cancer 89:2069–2077PubMedCrossRefGoogle Scholar
  11. 11.
    Clayton JM, Butow PN, Tattersall MHN et al (2007) Randomized controlled trial of a prompt list to help advanced cancer patients and their caregivers to ask questions about prognosis and end-of-life care. J Clin Oncol 25:715–723PubMedCrossRefGoogle Scholar
  12. 12.
    Cassileth BR, Zupkis RV, Sutton-Smith K et al (1980) Information and participation preferences among cancer patients. Ann Intern Med 92:832–836PubMedGoogle Scholar
  13. 13.
    Sutherland HJ, Llewellyn-Thomas HA, Lockwood GA et al (1989) Cancer patients: their desire for information and participation in treatment decisions. J Roy Soc Med 82:260–263PubMedGoogle Scholar
  14. 14.
    Spielberger CD (1983) Manual for the state-trait anxiety inventory (form Y). Consulting Psychologist, Palo AltoGoogle Scholar
  15. 15.
    Barry CA, Bradley CP, Britten N et al (2000) Patients unvoiced agendas in general practice consultations: qualitative study. BMJ 320:1246–1250PubMedCrossRefGoogle Scholar
  16. 16.
    Greenfield S, Kaplan S, Ware J (1985) Expanding patient involvement in care. Ann Intern Med 102(4):520–528PubMedGoogle Scholar
  17. 17.
    Street RL Jr (1991) Information giving in medical consultations: the influence of patients’ communicative styles and personal characteristics. Soc Sci Med 32:541–548PubMedCrossRefGoogle Scholar
  18. 18.
    Kirk P, Kirk I, Kristjanson LJ et al (2004) What do patients receiving palliative care for cancer and their families want to be told? A Canadian and Australian qualitative study. BMJ 328:1343–1347PubMedCrossRefGoogle Scholar
  19. 19.
    Degner LF, Sloan JA (1992) Decision-making during serious illness. What role do patients really want to play? J Clin Epidemiol 45:941–950PubMedCrossRefGoogle Scholar
  20. 20.
    Butow PN, Maclean M, Dunn SM et al (1997) The dynamics of change: cancer patients’ preferences for information involvement and support. Ann Oncol 8:857–863PubMedCrossRefGoogle Scholar
  21. 21.
    Eggly S, Penner LA, Greene M et al (2006) Information seeking during “bad news” oncology interactions: question asking by patients and their companions. Soc Sci Med 63:2974–2985PubMedCrossRefGoogle Scholar
  22. 22.
    Katz MG, Jacobson TA, Veledar E et al (2007) Patient literacy and question-asking behavior during the medical encounter: a mixed-methods analysis. J Gen Intern Med 22:782–786PubMedCrossRefGoogle Scholar
  23. 23.
    Elkin, Kim SHM, Casper ES, Kissane DW, Schrag D (2007) Desire for information and involvement in treatment decisions: elderly cancer patients’ preferences and their physicians’ perceptions. J Clin Oncol 25:5275–5280PubMedCrossRefGoogle Scholar
  24. 24.
    Cegala DJ, McClure L, Marinelli TM, Post DM (2000) The effects of communication skills training on patients’ participation during medical interviews. Patient Educ Couns 41:209–222PubMedCrossRefGoogle Scholar
  25. 25.
    Kinnersley P, Edwards A, Hood K, Ryan R, Prout H, Cadbury N, MacBeth F, Butow P, Butler C (2008) Interventions before consultations to help patients address their information needs by encouraging question asking: systematic review. BMJ 337:a485PubMedCrossRefGoogle Scholar
  26. 26.
    Harrington J, Noble LM, Newman SP (2004) Improving patients’ communication with doctors: a systematic review of intervention studies. Patient Educ Couns 52(1):7–16PubMedCrossRefGoogle Scholar
  27. 27.
    Clayton JM, Hancock KM, Butow PN et al (2007) Clinical practice guidelines for communicating prognosis and end-of-life issues with adults in the advanced stages of a life-limiting illness, and their caregivers. M J Aust 186(suppl):S77–S108Google Scholar
  28. 28.
    Clayton J, Butow P, Tattersall M (2010) Asking questions can help: an aid for people seeing the palliative care team. Canberra, Palliative Care Australia, in English 2006, in 21 different languages, http://www.palliativecare.org.au/portals/46/resources/AskingQuestionsCanHelp.pdf

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Josephine M. Clayton
    • 1
    • 2
    • 5
    • 6
  • Christine Natalia
    • 1
    • 2
  • Phyllis N. Butow
    • 1
    • 3
  • Judy M. Simpson
    • 4
  • Angela M. O’Brien
    • 1
  • Rhonda Devine
    • 1
  • Martin H. N. Tattersall
    • 1
    • 2
  1. 1.Centre for Medical Psychology and Evidence-based Decision-makingUniversity of SydneySydneyAustralia
  2. 2.Sydney Medical SchoolUniversity of SydneySydneyAustralia
  3. 3.School of PsychologyUniversity of SydneySydneyAustralia
  4. 4.School of Public HealthUniversity of SydneySydneyAustralia
  5. 5.Hammond Care Palliative and Supportive Care Service, Greenwich HospitalSydneyAustralia
  6. 6.Department of Palliative CareRoyal North Shore HospitalSydneyAustralia

Personalised recommendations